Egan’s Fundamentals of Respiratory Care 10th Edition by Robert M. Kacmarek – Test Bank

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Egan’s Fundamentals of Respiratory Care 10th Edition by Robert M. Kacmarek – Test Bank

Chapter 02: Quality and Evidence-Based Respiratory Care

Test Bank

 

MULTIPLE CHOICE

 

  1. Quality in the practice of respiratory care encompasses which of the following?
a. personnel performing care
b. equipment used
c. method or manner in which care is provided
d. level of experience of respiratory care providers
e. all of the above

 

 

ANS:  E

Quality, as applied to the practice of respiratory care, is multidimensional. It encompasses the personnel who perform respiratory care, the equipment used, and the method or manner in which care is provided.

 

DIF:    Recall             REF:   p. 20              OBJ:   1

 

  1. Who is professionally responsible for the clinical function of the respiratory care department?
a. shift supervisor
b. department head
c. medical director
d. clinical supervisor
e. senior pulmonologist

 

 

ANS:  C

The medical director of respiratory care is professionally responsible for the clinical function of the department and provides oversight of the clinical care that is delivered (Box 2-1).

 

DIF:    Recall             REF:   p. 21              OBJ:   1

 

  1. What is the most essential aspect of providing quality respiratory care?
a. Care being provided is indicated.
b. Care is delivered competently and appropriately.
c. Patient is appropriately evaluated by physician before care is initiated.
d. A and B.
e. A, B, and C.

 

 

ANS:  D

The medical director of respiratory care is professionally responsible for the clinical function of the department and provides oversight of the clinical care that is delivered (Box 2-1).

 

DIF:    Recall             REF:   p. 21              OBJ:   2

 

  1. The medical director of respiratory care is responsible for all the following except:
a. supervision of ongoing quality assurance activities
b. supervision of respiratory therapists performing pulmonary function testing
c. participation in the selection and promotion of technical staff
d. medical direction of the in-service and educational programs
e. establishment of safety and equipment effectiveness standards

 

 

ANS:  E

Perhaps the most essential aspect of providing quality respiratory care is to ensure that the care being provided is indicated and that it is delivered competently and appropriately.

 

DIF:    Recall             REF:   p. 21              OBJ:   1

 

  1. What is the chief reason that respiratory care protocols were developed and are currently being used in hospitals throughout North America?
a. enhance proper allocation of respiratory care services
b. decrease patient care costs to hospitals and insurance companies
c. expand patient care skills among respiratory care providers
d. enhance efficiency of respiratory care personnel in providing patient care
e. justify reasons for increasing patient care costs

 

 

ANS:  A

Misallocation has led to the use of respiratory care protocols that are implemented by respiratory therapists (as described under “Methods for Enhancing the Quality of Respiratory Care”).

 

DIF:    Application    REF:   p. 21              OBJ:   1

 

  1. Which of the following factors is important in determining the quality of care delivered by a respiratory therapist?
a. education
b. experience
c. training
d. all the above
e. none of the above

 

 

ANS:  D

The quality of respiratory therapists depends primarily on their training, education, experience, and professionalism.

 

DIF:    Recall             REF:   p. 21              OBJ:   1

 

  1. For the CRT credential, what does the letter “T” stand for?
a. therapist
b. technician
c. trainee
d. teacher
e. none of the above

 

 

ANS:  A

Currently, there are two levels of general practice credentialing in respiratory care: (1) certified respiratory therapists (CRTs) and (2) registered respiratory therapists (RRTs).

 

DIF:    Recall             REF:   p. 21              OBJ:   1

 

  1. Respiratory care education programs are reviewed by which committee to ensure quality?
a. Committee for Accreditation of Respiratory Care
b. American Association for Respiratory Care Education
c. Joint Review Committee Respiratory Care Education
d. Respiratory Care Education Committee
e. none of the above

 

 

ANS:  A

Respiratory care education programs are reviewed by the Committee on Accreditation for Respiratory Care (CoARC).

 

DIF:    Recall             REF:   p. 22              OBJ:   1

 

  1. The word “credentialing” in general refers to what?
a. recognition of an individual in the profession
b. licensure by a state or national organization
c. successful completion of entry-level board examination
d. voluntary certification by state agency
e. not used in the field of respiratory care

 

 

ANS:  A

“Credentialing” is a general term that refers to the recognition of individuals in particular occupations or professions.

 

DIF:    Recall             REF:   p. 23              OBJ:   1

 

  1. What term is used to describe the process in which a government agency gives an individual permission to practice an occupation?
a. certification
b. licensure
c. registry
d. credentialing
e. none of the above

 

 

ANS:  B

Licensure is the process in which a government agency gives an individual permission to practice an occupation.

 

DIF:    Recall             REF:   p. 23              OBJ:   1

 

  1. What agency is responsible for ensuring quality in respiratory care through voluntary certification and registration?
a. JRCRTE
b. CoARC
c. NBRC
d. AARC
e. CAAHE

 

 

ANS:  C

The primary method of ensuring quality in respiratory care is voluntary certification or registration conducted by the National Board for Respiratory Care (NBRC).

 

DIF:    Recall             REF:   p. 23              OBJ:   1

 

  1. What organization is responsible for credentialing respiratory therapists?
a. AARC
b. ATS
c. NBRC
d. ACCP
e. all the above

 

 

ANS:  C

The primary method of ensuring quality in respiratory care is voluntary certification or registration conducted by the National Board for Respiratory Care (NBRC).

 

DIF:    Recall             REF:   p. 23              OBJ:   1

 

  1. Which of the following is/are characteristics of a respiratory care professional?
a. participates in continuing education activities
b. obtains professional credentials
c. adheres to a code of ethics
d. completes an accredited education program
e. all of the above

 

 

ANS:  E

A professional is characterized as an individual conforming to the technical and ethical standards of a profession. Respiratory therapists demonstrate their professionalism by maintaining the highest practice standards, by engaging in ongoing learning, by conducting research to advance the quality of respiratory care, and by participating in organized activities through professional societies such as the American Association for Respiratory Care and associated state societies. Box 2-3 lists the professional attributes of a respiratory therapist.

 

DIF:    Recall             REF:   p. 24              OBJ:   1

 

  1. HIPAA was established in 1996 to set standards related to sharing confidential health history information about patients. What does the letter “P” stand for?
a. privacy
b. portability
c. patient
d. protection
e. people

 

 

ANS:  B

HIPAA is the Health Insurance Portability and Accountability Act.

 

DIF:    Recall             REF:   p. 26              OBJ:   1

 

  1. Responsibility for the technical direction of a respiratory care department lies with whom?
a. medical director
b. department manager
c. hospital administrator
d. shift supervisor
e. hospital biomedical engineering department

 

 

ANS:  B

Technical direction is often the responsibility of the manager of a respiratory care department, who must make sure the equipment and the associated protocols and procedures have sufficient quality to ensure the safety, health, and welfare of the patient using the equipment.

 

DIF:    Recall             REF:   p. 24              OBJ:   1

 

  1. The responsibilities of a respiratory care department manager include all of the following except:
a. check that medical devices function at an appropriate and safe level
b. develop respiratory care protocols and procedures
c. regulate medications delivered by respiratory care staff
d. maintain knowledge of changes in medications and delivery devices
e. evaluate new devices and methods for effectiveness commensurate with cost

 

 

ANS:  C

Those responsible for technical direction must be certain that these new devices, methods, and strategies not only are effective but also deliver a benefit commensurate with the cost.

 

DIF:    Recall             REF:   p. 24              OBJ:   2

 

  1. Which of the following is a key element of a respiratory care protocol program?
a. strong and committed medical direction
b. collaborative environment among health care providers
c. responsiveness to address and correct problems
d. capable therapists
e. all of the above

 

 

ANS:  E

The success of a respiratory care protocol program requires several key elements including active and committed medical direction, capable respiratory therapists, collaboration with physicians and nurses, careful monitoring, and a responsive hospital environment. (Box 2-5).

 

DIF:    Recall             REF:   p. 27              OBJ:   2

 

  1. Which of the following is an essential element of a comprehensive protocol program?
a. carefully structured assessment tool and care plan form
b. active quality monitoring
c. comprehensive delineation of boundaries between respiratory care, nursing, and physician personnel
d. both B and C
e. none of the above

 

 

ANS:  A

A carefully structured assessment tool and care plan form (Figures 2-3 and 2-4) are essential elements for a comprehensive protocol program.

 

DIF:    Application    REF:   p. 28              OBJ:   2

 

  1. What voluntary accrediting agency monitors quality in respiratory care departments?
a. JRCRTE
b. AARC
c. FDA
d. The Joint Commission
e. AMA

 

 

ANS:  D

The Joint Commission requires a hospital service to have a quality assurance plan to provide a system for controlling quality.

 

DIF:    Recall             REF:   p. 31              OBJ:   1

 

  1. Current Joint Commission standards for accreditation emphasize which of the following?
a. continual quality improvement
b. therapist-driven protocols
c. license and registration of health care providers
d. health, welfare, and safety of patients using respiratory care equipment
e. development of continuing education programs for health care providers

 

 

ANS:  A

Current Joint Commission standards for accreditation emphasize organization-wide efforts for continuous quality improvement (CQI).

 

DIF:    Application    REF:   p. 31              OBJ:   1

 

  1. To monitor correctness of respiratory care plans, which of the following should be used?
a. nursing care plans
b. physician progress notes
c. care plan auditors and case study exercises
d. daily patient rounds with medical director
e. regular multidisciplinary patient rounds

 

 

ANS:  C

Specific methods to monitor the quality of respiratory care protocol programs include conducting care plan audits in real time and ensuring practitioner training by using case study exercises.

 

DIF:    Application    REF:   p. 33              OBJ:   2

 

  1. Respiratory care plans may be monitored by which of the following?
a. experienced care plan auditors
b. computerized case study exercises
c. patient scenarios
d. comparison of therapist’s patient assessment with the department’s “gold standard” assessment
e. all of the above

 

 

ANS:  E

The assessment sheets and the care plans are then compared with the “gold standard,” or correct assessments and care plans as determined by the consensus of the education coordinator and the supervisors.

 

DIF:    Recall             REF:   p. 33              OBJ:   3

 

  1. What system has the federal government developed to evaluate the quality of care given to Medicare beneficiaries?
a. hospital restructuring and design
b. patient-focused care
c. peer review organizations (PROs)
d. protocols
e. case study reviews

 

 

ANS:  C

In addition to the voluntary accreditation process that health care organizations use to help ensure that patients are receiving quality care, the federal government has established an elaborate system of PROs to evaluate the quality and appropriateness of care given to Medicare beneficiaries.

 

DIF:    Recall             REF:   p. 33              OBJ:   2

 

  1. Hospital restructuring and redesign have involved all of the following except:
a. cross-training employees and using unlicensed assistive staff
b. nursing unit having its own admitting and medical laboratory facilities
c. downsizing and decentralizing high-budget, labor-intensive departments
d. deploying respiratory care personnel to individual nursing units
e. training multiskilled assistive personnel to perform basic patient care

 

 

ANS:  B

Approaches for restructuring commonly include cross-training employees, using unlicensed assistive staff, and decentralizing services by bringing them directly to the patient.

 

DIF:    Application    REF:   p. 33              OBJ:   3

 

  1. The effectiveness of the patient-focused care model has been limited by which one of the following?
a. requirement that each nursing unit has its own admitting, x-ray unit, medical laboratory, pharmacy, and physical therapy facilities
b. reduction of the number of health care providers for patients
c. expense of relocating radiology, pharmacy, and laboratory services to nursing units
d. assignment of cross-trained personnel to specific units
e. expense of training multiskilled personnel to perform patient care

 

 

ANS:  C

The obvious challenges of the patient-focused care model (e.g., decentralizing equipment, extensive cross-training, etc.) explain its very limited adoption.

 

DIF:    Application    REF:   p. 33              OBJ:   2

 

  1. What is one advantage that has been shown of respiratory care protocols?
a. increase in the number of procedures performed by respiratory care providers
b. decrease in the overordering of respiratory care services
c. decrease in the cost savings to respiratory care departments
d. decrease in the cost of performing each respiratory care procedure
e. decrease in the demand for qualified respiratory care providers

 

 

ANS:  B

Most studies show a significant decrease in overordering respiratory care services.

 

DIF:    Application    REF:   p. 35              OBJ:   2

 

  1. What term is used in current healthcare that refers to an organized strategy of delivering care to a large group of individuals?
a. patient-focused care
b. protocol-based medicine
c. disease management
d. evidence-based medicine

 

 

ANS:  C

Disease management refers to an organized strategy of delivering care to a large group of individuals with chronic disease in order to improve outcomes and reduce cost.

 

DIF:    Recall             REF:   p. 36              OBJ:   4

 

  1. Treatment based on careful review of available literature is known as:
a. evidence-based medicine
b. protocol-based medicine
c. review-based medicine
d. team health care

 

 

ANS:  A

Evidence-based medicine refers to an approach to determining optimal clinical management based on several practices.

 

DIF:    Recall             REF:   p. 36              OBJ:   5

 

  1. What term is used to describe the work done by a researcher who reviews numerous studies on a single topic and gives more weight to the more rigorous ones before making recommendations?
a. state-of-the-art paper
b. meta-analysis
c. alpha review
d. apical review
e. none of the above

 

 

ANS:  B

Meta-analyses assess the quality of available evidence and gives weight to better-designed, more rigorous studies.

 

DIF:    Recall             REF:   p. 38              OBJ:   5

 

  1. How are competencies being used to monitor the quality of respiratory care?
a. They focus on cost saving strategies.
b. They are used to check the skill and knowledge of respiratory through the use of clinical simulations.
c. They are used to educate therapist on new treatments and procedures.
d. They are used to review protocols

 

 

ANS:  B

The purpose of competencies is to check for having suitable and sufficient skills, knowledge and experience for specific tasks.

 

DIF:    Recall             REF:   p. 31              OBJ:   3

 

  1. Which organization is an emerging model of health care providers that work to meet quality and care targets, receive and disburse payments?
a. NBRC
b. CDC
c. ACO
d. The Joint Commission

 

 

ANS:  C

Accountable care organizations (ACOs) is an emerging group of health care providers that work to enhance the quality of care, receive payments, and lessen costs.

 

DIF:    Recall             REF:   p. 33              OBJ:   2

 

  1. What is/are the essential components comprise disease management programs?
a. an integrated healthcare system that can provide a full range of a patient’s needs
b. a knowledge regarding prevention, diagnosis, and treatment of diseases
c. a commitment to CQI
d. a sophisticated clinical and administrative information system that helps assess patterns in the clinical practice
e. all of the above

 

 

ANS:  E

All of the above are the essential components for a disease management team to be successful at meeting the clinical needs of the patients and hospital.

 

DIF:    Recall             REF:   p. 33              OBJ:   4

 

  1. What is a cohort study?
a. comparing the clinical outcomes from two different groups
b. single patient study
c. a literature-based review
d. collection of patients with similar clinical situations

 

 

ANS:  A

Cohort studies, which compare the clinical outcomes in two compared groups (or cohorts), generally have greater scientific rigor than case studies or case series and consist of two broad types of study designs: observational cohort studies and randomized controlled trials.

 

DIF:    Recall             REF:   p. 36              OBJ:   5

 

  1. What are the key outcomes that are looked at in different types of studies?
a. patient survival
b. discharge from ICU
c. organ system failure
d. all of the above

 

 

ANS:  D

All three are important key out comes that are evaluated and compared when looking at study results.

 

DIF:    Recall             REF:   p. 37              OBJ:   5

 

Chapter 14: Regulation of Breathing

Test Bank

 

MULTIPLE CHOICE

 

  1. In what location are the inspiratory and expiratory centers found?
a. pedulla
b. neurons in the cerebellum
c. pons
d. No such centers exist.

 

 

ANS:  D

Recent evidence shows that inspiratory and expiratory neurons are anatomically intermingled and do not necessarily inhibit one another. No clearly separate inspiratory and expiratory centers exist.

 

DIF:    Recall             REF:   p. 315            OBJ:   1

 

  1. The medulla oblongata contains which of the following areas?
  2. apneustic center
  3. dorsal respiratory group neurons (DRGs)
  4. pneumotaxic center
  5. ventral respiratory group neurons (VRGs)
a. 1, 2, and 3
b. 2 and 4
c. 3 only
d. 1, 2, 3, and 4

 

 

ANS:  B

Instead, the medulla contains several widely dispersed respiratory-related neurons, as shown in Figure 14-1. The DRGs contain mainly inspiratory neurons, whereas the VRGs contain both inspiratory and expiratory neurons.

 

DIF:    Recall             REF:   p. 315            OBJ:   1

 

  1. Sensory input to the dorsal respiratory neurons from the lungs, airways, and peripheral chemoreceptors is provided via which nerves?
  2. glossopharyngeal
  3. phrenic
  4. vagus
a. 1 and 2
b. 1
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  C

The vagus and glossopharyngeal nerves transmit many sensory impulses to the DRGs from the lungs, airways, peripheral chemoreceptors, and joint proprioceptors. These impulses modify the basic breathing pattern generated in the medulla.

 

DIF:    Recall             REF:   p. 315            OBJ:   1

 

  1. To which anatomic structures do the ventral respiratory centers send motor signals during inspiration?
  2. diaphragm
  3. larynx
  4. pharynx
  5. sternocleidomastoids
a. 1, 2, and 3
b. 2 and 4
c. 1 only
d. 1, 2, 3, and 4

 

 

ANS:  A

Some inspiratory VRG neurons send motor impulses through the vagus nerve to the laryngeal and pharyngeal muscles, abducting the vocal cords and increasing the diameter of the glottis. Other VRG inspiratory neurons transmit impulses to the diaphragm and external intercostal muscles.

 

DIF:    Recall             REF:   p. 315            OBJ:   1

 

  1. The inhibitory neurons that switch off the inspiratory ramp signal are controlled by which of the following?
  2. apneustic center
  3. pneumotaxic center
  4. pulmonary stretch receptors
a. 1, 2, and 3
b. 1 and 2
c. 3
d. 2 and 3

 

 

ANS:  D

The inhibitory neurons that switch off the inspiratory ramp signal are controlled by the pneumotaxic center and pulmonary stretch receptors.

 

DIF:    Recall             REF:   p. 316            OBJ:   2

 

  1. What centers are located in the pons of the brain stem?
  2. apneustic center
  3. dorsal respiratory neurons
  4. pneumotaxic center
a. 1, 2, and 3
b. 2 and 3
c. 1 and 3
d. 1 and 2

 

 

ANS:  C

Figure 14-1 shows two groups of neurons in the pons: (1) the apneustic center and (2) the pneumotaxic center.

 

DIF:    Recall             REF:   p. 316            OBJ:   1

 

  1. Failure to switch off the brainstem inspiratory neurons can result in which of the following?
a. apnea
b. apneustic breathing
c. Biot’s breathing
d. Cheyne-Stokes breathing

 

 

ANS:  B

Under such circumstances, the DRG inspiratory neurons fail to switch off, causing prolonged inspiratory gasps interrupted by occasional expirations (apneustic breathing).

 

DIF:    Recall             REF:   p. 316            OBJ:   2

 

  1. The pneumotaxic center controls which of the following?
a. response to changes in blood pH and PCO2
b. rhythm of the full breathing cycle
c. when inspiration switches off (the inspiratory time)
d. when inspiration switches on (the expiratory time)

 

 

ANS:  C

The pneumotaxic center controls the “switch-off” point of the inspiratory ramp, thus controlling inspiratory time.

 

DIF:    Recall             REF:   p. 316            OBJ:   2| 3

 

  1. What stimulates the Hering-Breuer inflation reflex?
a. the DRG when it is time to end inspiratory efforts
b. the stretch of receptors at high lung volumes
c. the VRG when it is time for inspiration
d. very low lung volumes stimulate inspiration

 

 

ANS:  B

In adults, the Hering-Breuer reflex is activated only at large tidal volumes (800 to 1000 ml or more) and, apparently, it is not an important control mechanism in quiet breathing.

 

DIF:    Recall             REF:   p. 316            OBJ:   4

 

  1. Which statements describe aspects of the Hering-Breuer reflex?
  2. It affects the rate and depth of breathing during exercise.
  3. It is only activated at large tidal volumes in normal adults.
  4. Its impulses travel via the vagus nerve to the dorsal respiratory groups (DRGs).
  5. Its receptors are located in the large and small airways.
a. 1
b. 1 and 2
c. 2, 3, and 4
d. 1, 2, 3, and 4

 

 

ANS:  D

The Hering-Breuer inflation reflex, described by H. E. Hering and Josef Breuer in 1868, is generated by stretch receptors located in the smooth muscle of both large and small airways. When lung inflation stretches these receptors, they send inhibitory impulses through the vagus nerve to the DRG neurons, stopping further inspiration. In this way, the Hering-Breuer reflex has an effect similar to that of the pneumotaxic center. In adults, the Hering-Breuer reflex is activated only at large tidal volumes (800 to 1000 ml or more) and, apparently, it is not an important control mechanism in quiet breathing. However, this reflex is important in regulating respiratory rate and depth during moderate to strenuous exercise.

 

DIF:    Recall             REF:   p. 316-317     OBJ:   4

 

  1. What is the effect when the deflation reflex is stimulated?
a. a strong inspiratory effort
b. expiration is initiated
c. cuts off all inspiratory signals
d. stimulates the termination of expiration

 

 

ANS:  A

Sudden collapse of the lung stimulates strong inspiratory efforts (deflation reflex).

 

DIF:    Recall             REF:   p. 317            OBJ:   4

 

  1. What reflex is associated with the sensory stimulation of the pulmonary stretch receptors that stimulate a deeper breath upon inspiration?
a. carotid
b. Head’s paradoxical
c. Hering-Breuer
d. J receptor

 

 

ANS:  B

If the Hering-Breuer reflex is blocked by cooling the vagus nerve, lung hyperinflation causes a further increase in inspiratory effort, the opposite of the Hering-Breuer reflex. The receptors for this reflex are called rapidly adapting receptors, because they stop firing promptly after a volume change occurs. Head’s reflex may help maintain large tidal volumes during exercise and may be involved in periodic deep sighs during quiet breathing.

 

DIF:    Recall             REF:   p. 317            OBJ:   4

 

  1. What receptors are associated with causing coughing, sneezing, and tachypnea when stimulated?
a. irritant receptors
b. J receptors
c. muscle spindles
d. peripheral proprioceptor

 

 

ANS:  A

Rapidly adapting irritant receptors in the epithelium of the larger conducting airways have vagal sensory nerve fibers. Their stimulation, whether by inhaled irritants or by mechanical factors, causes reflex bronchoconstriction, coughing, sneezing, tachypnea, and narrowing of the glottis.

 

DIF:    Recall             REF:   p. 317            OBJ:   4

 

  1. What negative responses can be elicited by suctioning a patient’s airway?
  2. bradycardia
  3. coughing
  4. laryngospasm
  5. severe bronchospasm
a. 1, 2, and 3
b. 2 and 4
c. 3 only
d. 1, 2, 3, and 4

 

 

ANS:  D

Suctioning may result in laryngospasm, coughing, and slowing of the heartbeat. Endotracheal intubation, airway suctioning, and bronchoscopy readily elicit vagovagal reflexes. Physical stimulation of the conducting airways, as with suctioning or bronchoscopy, may cause a severe case of bronchospasm, coughing, and laryngospasm.

 

DIF:    Recall             REF:   p. 317            OBJ:   4

 

  1. Stimulation of the irritant receptors in the lung can result in which of the following?
  2. bronchoconstriction
  3. coughing
  4. narrowing of the glottis
a. 1
b. 1 and 3
c. 1, 2, and 3
d. 1 and 3

 

 

ANS:  C

Irritant receptors are responsible for laryngospasm, coughing, and slowing of the heartbeat. Endotracheal intubation, airway suctioning, and bronchoscopy readily elicit vagovagal reflexes. Physical stimulation of the conducting airways, as with suctioning or bronchoscopy, may cause a severe case of bronchospasm, coughing, and laryngospasm.

 

DIF:    Recall             REF:   p. 317            OBJ:   4

 

  1. Which of the following can cause laryngospasm and bradycardia through a vagovagal reflex?
  2. bronchoscopy
  3. endotracheal intubation
  4. tracheal suctioning
a. 1
b. 1 and 3
c. 1, 2, and 3
d. 1 and 2

 

 

ANS:  C

Such reflexes are responsible for laryngospasm, coughing, and slowing of the heartbeat. Endotracheal intubation, airway suctioning, and bronchoscopy readily elicit vagovagal reflexes. Physical stimulation of the conducting airways, as with suctioning or bronchoscopy, may cause a severe case of bronchospasm, coughing, and laryngospasm.

 

DIF:    Recall             REF:   p. 317            OBJ:   4

 

  1. What receptors cause a rapid shallow breathing pattern when stimulated by pulmonary disease?
a. irritant receptors
b. J receptors
c. muscle spindles
d. peripheral proprioceptors

 

 

ANS:  B

C fibers in the lung parenchyma near the pulmonary capillaries are called juxtacapillary receptors, or J receptors. Alveolar inflammatory processes (pneumonia), pulmonary vascular congestion (congestive heart failure), and pulmonary edema stimulate these receptors. This stimulation causes rapid, shallow breathing; a sensation of dyspnea; and expiratory narrowing of the glottis.

 

DIF:    Recall             REF:   p. 317            OBJ:   4

 

  1. Pulmonary J receptors can be stimulated by which of the following?
  2. edema
  3. inflammatory processes
  4. pulmonary vascular congestion
a. 1 and 3
b. 1
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  D

C fibers in the lung parenchyma near the pulmonary capillaries are called juxtacapillary receptors, or J receptors. Alveolar inflammatory processes (pneumonia), pulmonary vascular congestion (congestive heart failure), and pulmonary edema stimulate these receptors. This stimulation causes rapid, shallow breathing; a sensation of dyspnea; and expiratory narrowing of the glottis.

 

DIF:    Recall             REF:   p. 317            OBJ:   4

 

  1. Which of the following is NOT an effect of J receptor stimulation?
a. deep breathing
b. dyspnea
c. glottic narrowing
d. rapid breathing

 

 

ANS:  A

Stimulation of J receptors can result in rapid, shallow breathing; a sensation of dyspnea; and expiratory narrowing of the glottis.

 

DIF:    Recall             REF:   p. 317            OBJ:   4

 

  1. What receptors are known to cause an increase in ventilation when the patient’s limbs are moved or cold water is splashed on the patient’s face?
a. irritant receptors
b. J receptors
c. muscle spindles
d. peripheral proprioceptors

 

 

ANS:  D

Proprioceptors in muscles, tendons, and joints, as well as pain receptors in muscles and skin, send stimulatory signals to the medullary respiratory center. Such stimuli increase medullary inspiratory activity and cause hyperpnea. For this reason, moving the limbs, slapping or splashing cold water on the skin, and other painful stimuli stimulate ventilation in patients with respiratory depression.

 

DIF:    Recall             REF:   p. 317            OBJ:   4

 

  1. Which receptors are primarily responsible for the initial increase in ventilation that occurs at the beginning of exercise?
a. carotid chemoreceptors
b. irritant receptors
c. J receptors
d. proprioceptors

 

 

ANS:  D

Proprioceptors in joints and tendons may be important in initiating and maintaining increased ventilation at the beginning of exercise.

 

DIF:    Recall             REF:   p. 317            OBJ:   4

 

  1. Adjustment of respiratory muscle contractions to accommodate varying loads is regulated by which of the following?
a. medullary respiratory centers
b. muscle spindle fiber feedback
c. pontine apneustic center
d. pontine pneumotaxic center

 

 

ANS:  B

Muscle spindles in the diaphragm and intercostal muscles are part of a reflex arc that helps the muscles adjust to an increased load.

 

DIF:    Recall             REF:   p. 317            OBJ:   4

 

  1. What group of nerve cells senses and responds to changes in the chemical composition of its fluid environment?
a. chemoreceptors
b. Gamma-efferent system
c. muscle spindle fibers
d. proprioceptors

 

 

ANS:  A

Hypercapnia, acidemia, and hypoxemia stimulate specialized nerve structures called chemoreceptors.

 

DIF:    Recall             REF:   p. 318            OBJ:   5

 

  1. Where are the peripheral chemoreceptors located?
  2. in the arch of the aorta
  3. in the bifurcations of carotid arteries
  4. on the ventrolateral surfaces of the medulla
a. 1 and 2
b. 1
c. 2 and 3
d. 1, 2, and 3

 

 

ANS:  A

Peripherally located chemoreceptors are found in the fork of the common carotid arteries and the aortic arch.

 

DIF:    Recall             REF:   p. 318            OBJ:   5

 

  1. What has the primary responsibility for sensing and responding to changes in blood levels of CO2?
a. apneustic centers
b. central chemoreceptors
c. peripheral chemoreceptors
d. pneumotaxic center

 

 

ANS:  B

Hydrogen ions stimulate highly responsive chemosensitive nerve cells, located bilaterally in the medulla. Nevertheless, these central chemoreceptors are extremely sensitive to CO2 in an indirect fashion. Through the hydrolysis reaction, as CO2 increases there is a greater release of hydrogen ions to which the chemoreceptors respond

 

DIF:    Recall             REF:   p. 318            OBJ:   5

 

  1. Which of the following is indirectly responsible for minute-to-minute control of breathing?
a. CO2 levels
b. HCO3 levels
c. lactate levels
d. O2 levels

 

 

ANS:  A

As the H+ ions in the CSF are generated in direct relation to the level of arterial PCO2, it is really the arterial PCO2 that (indirectly) controls primary minute-to-minute ventilation.

 

DIF:    Recall             REF:   p. 318            OBJ:   5

 

  1. In the face of chronically elevated levels of CO2, what happens to the response mediated by the central chemoreceptors?
a. It is accentuated or increased.
b. It is muted or decreased.
c. There is no change in the response.
d. There is no way to predict the body’s response.

 

 

ANS:  B

The stimulatory effect of chronically high CO2 on the central chemoreceptors gradually declines over 1 or 2 days, because the kidneys retain bicarbonate ions in response to respiratory acidosis, bringing the blood pH level back toward normal.

 

DIF:    Recall             REF:   p. 318            OBJ:   5

 

  1. Which of the following causes hypoxic stimulation of the carotid bodies?
  2. large decrease in arterial PO2
  3. large decrease in oxygen content
  4. CO2 poisoning
a. 1 only
b. 1 and 2
c. 1, 2, and 3
d. 1 and 3

 

 

ANS:  A

When the PaO2 is low carotid body sensitivity to a given [H+] increases; in this way hypoxemia increases ventilation for any given pH.

 

DIF:    Recall             REF:   p. 319            OBJ:   6

 

  1. Both anemia and carbon monoxide (CO) poisoning can cause severe hypoxia, yet neither condition results in a major stimulation of breathing. Why is this so?
a. The peripheral chemoreceptors do not respond to low oxygen content.
b. Anemia and CO poisoning depress the peripheral chemoreceptors.
c. Anemia and CO poisoning depress the central chemoreceptors.
d. Anemia and CO cause stagnant hypoxia, not hypoxemia.

 

 

ANS:  A

Because of their extremely high blood-flow rates, the carotid bodies respond to decreased arterial partial pressure of oxygen rather than to an actual decrease in arterial oxygen content.

 

DIF:    Recall             REF:   p. 319            OBJ:   6

 

  1. Stimulation to increase ventilation does not occur until the PaO2 falls below what level?
a. 90 mm Hg
b. 80 mm Hg
c. 70 mm Hg
d. 60 mm Hg

 

 

ANS:  D

When pH and PaCO2 are normal (pH = 7.40 and PaCO2 = 40 mm Hg), the carotid bodies’ nerve-impulse transmission rate does not increase significantly until the PaO2 decreases to about 60 mm Hg.

 

DIF:    Recall             REF:   p. 319            OBJ:   6

 

  1. Why does it take about 24 hours for a full ventilatory response to develop to acute hypoxemia?
a. Initial cerebrospinal fluid alkalemia blunts the hypoxic ventilatory stimulus.
b. Peripheral chemoreceptors are slow to respond to decreased blood oxygen levels.
c. Renal compensation for respiratory alkalosis increases chemoreceptor sensitivity.
d. A full ventilatory response is not possible until after the muscles become fatigued.

 

 

ANS:  A

High altitude causes a healthy person’s ventilation to increase because low barometric pressure decreases the inspired PO2, and thus the arterial PO2, which in turn raises the sensitivity of peripheral chemoreceptors to hydrogen ions. The resulting increase in ventilation is less than expected though, because hyperventilation lowers the PaCO2 and raises arterial pH. The increased pH depresses the medullary respiratory center, counteracting the excitatory effect of a low PaO2 on peripheral chemoreceptors.

 

DIF:    Recall             REF:   p. 324            OBJ:   6

 

  1. Which of the following centers respond more strongly to high levels of CO2?
a. aortic chemoreceptors
b. carotid chemoreceptors
c. central chemoreceptors
d. ventral respiratory centers

 

 

ANS:  C

For a given increase in PaCO2 or hydrogen ion concentration, the carotid bodies are less responsive than the central chemoreceptors. The peripheral chemoreceptors account for only 20% to 30% of the ventilatory response to hypercapnia.

 

DIF:    Recall             REF:   p. 319            OBJ:   6

 

  1. Which respond more rapidly to high levels of CO2?
a. aortic chemoreceptors
b. carotid chemoreceptors
c. central chemoreceptors
d. ventral respiratory centers

 

 

ANS:  B

The carotid chemoreceptors respond to increased arterial hydrogen ion concentration more rapidly than do the central chemoreceptors.

 

DIF:    Recall             REF:   p. 319            OBJ:   6

 

  1. In the face of hyperoxia, what is the response of the peripheral chemoreceptors to hypercapnia?
a. There is a decreased drive to breathe.
b. There is an increased drive to breathe.
c. There is insufficient information.
d. There is virtually no response.

 

 

ANS:  D

High arterial PO2 (hyperoxia) decreases the peripheral chemoreceptors’ PCO2 sensitivity to almost zero.

 

DIF:    Recall             REF:   p. 319            OBJ:   6

 

  1. Coexisting arterial hypoxemia, acidemia, and high PaCO2 (i.e., asphyxia) will have what effect on the peripheral chemoreceptors?
a. There is a decreased drive to breathe.
b. There is a maximal increased drive to breathe.
c. There is insufficient information to make a determination.
d. There is virtually no response.

 

 

ANS:  B

Coexisting arterial hypoxemia, acidemia, and high PaCO2 (i.e., asphyxia) maximally stimulate the peripheral chemoreceptors.

 

DIF:    Recall             REF:   p. 319            OBJ:   6

 

  1. What happens in chronic hypercapnia?
  2. The central chemoreceptive response to CO2 is decreased.
  3. The cerebrospinal fluid pH is restored to normal.
  4. Responsiveness to increased CO2 is decreased.
a. 1
b. 1 and 2
c. 2 and 3
d. 1, 2, and 3

 

 

ANS:  D

If PaCO2 rises gradually over time, as might occur in severe COPD because of steadily deteriorating lung mechanics, the kidneys compensate by increasing the plasma bicarbonate concentration, keeping the arterial pH within normal limits. As plasma bicarbonate levels increase, these ions slowly diffuse across the blood-brain barrier, keeping cerebrospinal fluid pH in its normal range. The central chemoreceptors respond to hydrogen ion concentration, not the CO2 molecule; thus, they sense a normal pH environment, even though the PaCO2 is abnormally high.

 

DIF:    Recall             REF:   p. 319            OBJ:   6

 

  1. When given high concentrations of oxygen, a patient with chronic hypercapnia may develop a more serious respiratory acidosis. Which of the following might be contributing to the patient’s increased PCO2?
  2. worsening ventilation—perfusion (/) balance
  3. desensitization of the carotid bodies
  4. removal of the hypoxic stimulus
a. 1 and 2
b. 1 only
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  C

Nevertheless, the reduction in minute ventilation following oxygen breathing in advanced COPD is not always severe enough to account for the increased PaCO2. Some investigators suggest that oxygen breathing worsens the / relationships in the lungs and is responsible for the increase in PaCO2. Other investigators have suggested that oxygen-induced hypercapnia is caused by the combined effects of hypoxic stimulus removal and redistribution of / relationships in the lungs.

 

DIF:    Recall             REF:   p. 320            OBJ:   7| 8

 

  1. In what manner would oxygen therapy induce worsening / mismatch and thus a further elevation in CO2 in a chronically hypercapnic patient?
a. by improving blood flow to poorly ventilated alveoli
b. by decreasing blood flow to poorly ventilated alveoli
c. causing bronchoconstriction, which worsens gas flow to low / areas
d. causing bronchodilation, which improves gas flow to poorly ventilated alveoli

 

 

ANS:  A

Oxygen breathing causes more blood flow to be directed to poorly ventilated alveoli, which takes blood flow away from well-ventilated alveoli. The key point is that when already under-ventilated alveoli receive additional blood flow, blood PCO2 rises further. These events can occur without a fall in overall minute ventilation.

 

DIF:    Recall             REF:   p. 320            OBJ:   7| 8

 

  1. How should oxygen therapy be administered to chronically hypercapnic patients?
a. Avoid giving any supplemental oxygen.
b. Give as much oxygen as possible (60% to 100%).
c. Withhold oxygen until the patient is intubated.
d. Give as much oxygen as required to maintain adequate oxygenation.

 

 

ANS:  D

Oxygen should never be withheld from acutely hypoxemic COPD patients for fear of inducing hypoventilation and hypercapnia. Tissue oxygenation is an overriding priority; oxygen must never be withheld from exacerbated, hypoxemic COPD patients for any reason. This means the clinician must be prepared to mechanically support ventilation if oxygen administration induces severe hypoventilation.

 

DIF:    Recall             REF:   p. 321            OBJ:   8

 

  1. What is the response of a patient with chronic hypercapnia to a sudden acute rise in carbon dioxide?
a. In almost all of these patients, there will be no response.
b. The patient’s drive to breathe will be increased.
c. This will further depress his or her respiratory centers.
d. This will induce apnea and sudden death.

 

 

ANS:  B

Chronic hypercapnia does not mean that the medullary chemoreceptors cannot respond to further acute rises in PaCO2. A sudden elevation in PaCO2 immediately crosses the blood-brain barrier into the cerebrospinal fluid, generating H+ ions that subsequently stimulate the medullary chemoreceptors. This will increase the drive to breathe.

 

DIF:    Recall             REF:   p. 321            OBJ:   8

 

  1. Which of the following will occur during even strenuous exercise in a normal healthy individual?
a. Blood gases remain stable.
b. The arterial PCO2 rises.
c. The arterial pH falls.
d. The arterial PO2 falls.

 

 

ANS:  A

Strenuous exercise increases carbon dioxide production and oxygen consumption by as much as 20-fold. Ventilation normally keeps pace with CO2 production, keeping PaCO2, PaO2, and arterial pH constant. Because arterial blood gases do not change, elevated carbon dioxide or hypoxia does not stimulate ventilation in healthy individuals during exertion.

 

DIF:    Recall             REF:   p. 322            OBJ:   11

 

  1. While observing a patient’s breathing, you note that the depth and rate first increase, then decrease, followed by a period of apnea. Which of the following terms would you use in charting this observation?
a. apneustic breathing
b. Biot’s breathing
c. Cheyne-Stokes breathing
d. paradoxical breathing

 

 

ANS:  C

In Cheyne-Stokes respiration, respiratory rate and tidal volume gradually increase and then gradually decrease to complete apnea (absence of ventilation), which may last several seconds. Then tidal volume and breathing frequency gradually increase again, repeating the cycle.

 

DIF:    Recall             REF:   p. 322            OBJ:   11

 

  1. Cheyne-Stokes breathing may be caused by which of the following?
  2. brain injuries
  3. congestive heart failure
  4. metabolic acidosis
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  A

Cheyne-Stokes breathing occurs when cardiac output is low, as in congestive heart failure, delaying the blood transit time between the lungs and the brain. In this instance, changes in respiratory center PCO2 lag behind changes in arterial PCO2. For example, when an increased PaCO2 from the lungs reaches the respiratory neurons, ventilation is stimulated; this then lowers the arterial PCO2 level. By the time the reduced PaCO2 reaches the medulla to inhibit ventilation, hyperventilation has been in progress for an inappropriately long time. When blood from the lung finally does reach the medullary centers, the low PaCO2 greatly depresses ventilation to the point of apnea. Arterial PCO2 then rises, but a rise in respiratory center PCO2 is delayed because of low blood flow rate. The brain eventually does receive the high PaCO2 signal, and the cycle is repeated. Cheyne-Stokes respiration may also be caused by brain injuries in which the respiratory centers overrespond to changes in the PCO2 level.

 

DIF:    Recall             REF:   p. 322            OBJ:   11

 

  1. You observe a patient’s breathing pattern as very irregular, with periods of breathing interspersed with long periods of apnea. Which of the following terms would you use in charting this observation?
a. apneustic breathing
b. Biot’s respiration
c. Cheyne-Stokes breathing
d. Kussmaul’s breathing

 

 

ANS:  B

Biot’s respiration is similar to Cheyne-Stokes respiration, except that tidal volumes are of identical depth.

 

DIF:    Recall             REF:   p. 322            OBJ:   11

 

  1. Biot’s respiration is most frequently observed in patients with which of the following?
a. congestive heart failure
b. increased intracranial pressure
c. metabolic acidosis
d. peripheral nerve disorders

 

 

ANS:  B

Biot’s breathing occurs in patients with increased intracranial pressure, but the mechanism for this pattern is unclear.

 

DIF:    Recall             REF:   p. 322            OBJ:   11

 

  1. What does apneustic breathing indicate?
a. damage to the cerebrum
b. damage to the pons
c. spinal cord transaction
d. vagal nerve damage

 

 

ANS:  B

Apneustic breathing indicates damage to the pons.

 

DIF:    Recall             REF:   p. 322            OBJ:   11

 

  1. Causes of central neurogenic hyperventilation include which of the following?
  2. head trauma
  3. inadequate brain blood flow
  4. severe brain hypoxia
a. 2 and 3
b. 1 and 2
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  D

Central neurogenic hyperventilation is characterized by persistent hyperventilation driven by abnormal neural stimuli. It is related to midbrain and upper pons damage associated with head trauma, severe brain hypoxia, or lack of blood flow to the brain.

 

DIF:    Recall             REF:   p. 322            OBJ:   11

 

  1. In patients with closed-head injuries, what may happen if the patient has hypercapnia?
a. High CO2 increases the risk of psychotic events.
b. High CO2 levels cause cerebral vasodilation and improved oxygenation.
c. Severe cerebral vasoconstriction results in anoxia and stroke.
d. Vasodilation causes increased intracranial pressure and possibly stops blood flow.

 

 

ANS:  D

Increased PCO2 dilates cerebral vessels, raising cerebral blood flow, whereas decreased PCO2 constricts cerebral vessels and reduces cerebral blood flow. In patients with traumatic brain injury, the brain swells acutely; this raises the intracranial pressure in the rigid skull to such high levels that blood supply to the brain might be cut off, causing cerebral hypoxia (ischemia). That is, high intracranial pressure may exceed cerebral arterial pressure and stop blood flow.

 

DIF:    Recall             REF:   p. 322            OBJ:   10| 11

 

  1. Inspiratory neurons fire with an increased frequency for approximately 2 seconds and then abruptly switch off, allowing expiration to proceed for approximately 3 seconds. This action best describes:
a. coughing
b. quiet breathing
c. exercise
d. choking

 

 

ANS:  B

During quiet breathing, inspiratory neurons fire with increasing frequency for approximately 2 seconds and then abruptly switch off, allowing expiration to proceed for approximately 3 seconds. At the start of expiration, inspiratory neurons again fire briefly, retarding the early phase of expiration.

 

DIF:    Recall             REF:   p. 316            OBJ:   2

 

  1. A patient in the emergency room is displaying prolong inspiratory gasps interrupted by occasional expirations, what serious injury should be suspected on this patient?
  2. Pneumotaxic center has been severed.
  3. Vagus nerve has been severed.
  4. Glossopharyngeal nerve has be severed.
a. 2 and 3
b. 1 and 2
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  B

If a situation occurs where the higher pneumotaxic center and vagus nerves were severed, the DRG inspiratory neurons would fail to switch off, causing prolonged inspiratory gasps interrupted by occasional expirations (apneustic breathing). Vagal and pneumotaxic center impulses hold the apneustic center’s stimulatory effect on DRG neurons in check.

 

DIF:    Application    REF:   p. 316            OBJ:   3

 

  1. A healthy 33 year old woman relocates to an area approximately 8,000 feet above sea level. On her first day, she begins to hyperventilate, but in 24 hours she shows signs of recovery. What is the probable cause of her condition?
a. hypoxemia-mediated hyperventilation
b. hypercapnia
c. hyperoxia-mediated hyperventilation
d. increased H+

 

 

ANS:  A

High altitude causes a healthy person`s ventilation to increase because low barometric pressure decreases the inspired PO2, and thus the arterial PO2, which in turn raises the sensitivity of peripheral chemoreceptors to H+. The resulting increase in ventilation is less than expected, though, because hyperventilation lowers the PaCO2 and raises arterial pH.

 

DIF:    Application    REF:   p. 319            OBJ:   6

 

  1. Why does splashing cold water on the skin stimulate ventilation?
a. It decreases medullary inspiratory activity causing hyperpnea.
b. Hering-Breuer inflation reflex
c. It increases medullary inspiratory activity causing hyperpnea.
d. J-receptor

 

 

ANS:  C

Proprioceptors in muscles, tendons, and joints, as well as pain receptors in muscles and skin, send stimulatory signals to the medullary respiratory center. Such stimuli increase medullary inspiratory activity and cause hyperpnea. For this reason, moving the limbs, slapping or splashing cold water on the skin, and other painful stimuli stimulate ventilation in patients with respiratory depression.

 

DIF:    Recall             REF:   p. 317            OBJ:   4

 

Chapter 28: Lung Cancer

Test Bank

 

MULTIPLE CHOICE

 

  1. What percentage of all cancer deaths are related to lung cancer?
a. less than 10%
b. about 30%
c. about 50%
d. more than 60%

 

 

ANS:  B

In the United States, approximately 28% of cancer deaths are due to lung cancer.

 

DIF:    Recall             REF:   p. 624            OBJ:   1

 

  1. Which of the following comments regarding lung cancer is TRUE?
a. The incidence has risen over the past few decades.
b. It is the third leading cause of cancer deaths in the United States.
c. The peak incidence occurred in the mid-1970s.
d. Incidence has increased in women 40 to 58 years of age.

 

 

ANS:  A

The frequency of lung cancer deaths peaked in 1984 and declined until the end of the 1990’s and has leveled off since. In 2010 there were 187,000 cancer deaths.

 

DIF:    Recall             REF:   p. 624            OBJ:   1

 

  1. Approximately what percentage of all lung cancer is linked to smoking?
a. 55%
b. 70%
c. 85%
d. 100%

 

 

ANS:  C

Eighty-five percent to 90% of individuals with lung cancer have had direct exposure to tobacco.

 

DIF:    Recall             REF:   p. 624            OBJ:   2

 

  1. In what age group has smoking NOT been seen to decrease recently?
a. 18 to 24 years
b. 25 to 40 years
c. 45 to 60 years
d. older than 70 years

 

 

ANS:  A

A decrease in smoking has not been observed among adults 18 to 24 years of age.

 

DIF:    Recall             REF:   p. 625            OBJ:   2

 

  1. What age group has been targeted by tobacco companies as a primary source of new customers?
a. teenagers
b. women aged 21 to 35 years
c. men aged 21 to 35 years
d. men and women over 50 years of age

 

 

ANS:  A

In the context that a person who has not started smoking as a teenager is unlikely to ever become a smoker, the tobacco industry has focused on young people and developing countries as the primary sources of new customers.

 

DIF:    Recall             REF:   p. 625            OBJ:   2

 

  1. Other causes of lung cancer include all of the following EXCEPT which one?
a. asbestos
b. arsenic
c. chromium
d. microwave radiation

 

 

ANS:  D

Arsenic, asbestos, and chromium confer the highest risks.

 

DIF:    Recall             REF:   p. 626            OBJ:   2

 

  1. Which of the following is NOT a major histopathologic type of lung cancer?
a. adenocarcinoma
b. squamous cell carcinoma
c. small-cell carcinoma
d. ciliated cell carcinoma

 

 

ANS:  D

The non–small-cell cancer category consists of adenocarcinoma (including bronchoalveolar cell carcinoma), squamous cell carcinoma, large cell carcinoma, and variants (Figure 28-4).

 

DIF:    Recall             REF:   p. 627            OBJ:   3

 

  1. What composition of adenocarcinoma best describes its histopathology?
a. stratified epithelial cells
b. pleomorphic cells
c. polygonal cells
d. glandular structures

 

 

ANS:  D

See Table 28-2.

 

DIF:    Recall             REF:   p. 632            OBJ:   3

 

  1. Squamous cell carcinoma is composed of which of the following?
a. glandular structures from lung scars
b. common pulmonary stem cells
c. flattened stratified epithelial cells
d. multicentric stratified cells

 

 

ANS:  C

See Table 28-1.

 

DIF:    Recall             REF:   p. 628            OBJ:   4

 

  1. Which of the following best describes the cell characteristics in small cell carcinoma?
a. larger than lymphocyte nucleus
b. enlarged nuclei-differentiated cells
c. keratin structures throughout lung tissue
d. develops from a common pulmonary stem cell

 

 

ANS:  D

See Table 28-1.

 

DIF:    Application    REF:   p. 628            OBJ:   4

 

  1. What type of histopathologic cells is associated with large-cell carcinoma?
a. pleomorphic cells
b. glandular structures
c. stratified epithelial cells
d. pulmonary stem cells

 

 

ANS:  A

See Table 28-1.

 

DIF:    Recall             REF:   p. 628            OBJ:   4

 

  1. Which of the following is the most common type of lung cancer?
a. large cell
b. adenocarcinoma
c. squamous cell
d. small cell

 

 

ANS:  B

See Table 28-1.

 

DIF:    Recall             REF:   p. 628            OBJ:   5

 

  1. Which of the following is not associated with the clinical features of lung cancer?
a. local growth of tumor
b. metastasis extrathoracic or intrathoracic
c. associated pain or discomfort
d. paraneoplastic syndrome

 

 

ANS:  C

The clinical features of lung cancer result from the effects of local growth of the tumor, regional growth or spread through the lymphatic system, hematogenous (blood-borne) distant metastatic spread, and remote paraneoplastic effects from tumor products or immune cross-reaction with tumor antigens.

 

DIF:    Recall             REF:   p. 628            OBJ:   5

 

  1. Which of the following is NOT associated with local tumor growth in the central airways?
a. large airway obstruction
b. cough
c. hemoptysis
d. fine crackles

 

 

ANS:  D

Local growth in a central location (e.g., in a mainstem bronchus) can cause cough, hemoptysis, or features of large-airway obstruction.

 

DIF:    Recall             REF:   p. 628            OBJ:   5

 

  1. What type of lung cancer usually is seen as a central lesion that may obstruct airways and lead to atelectasis?
a. adenocarcinoma
b. squamous cell
c. large cell
d. bronchogenic carcinoma

 

 

ANS:  B

Squamous cell carcinoma and small-cell carcinoma are more likely to grow in a central location than other cell types.

 

DIF:    Recall             REF:   p. 628            OBJ:   5

 

  1. On a chest radiograph, large-cell carcinoma is commonly seen as what type of lesion?
a. central lesion
b. well-defined mass
c. bilateral nodules
d. unilateral nodules

 

 

ANS:  D

These will show a small spot (<3 cm in diameter) termed a nodule.

 

DIF:    Recall             REF:   p. 630            OBJ:   5

 

  1. Apical growth may be associated with which of the following syndromes?
a. Goodpasture
b. Pancoast
c. Miller
d. granulomatosis

 

 

ANS:  B

Apical growth may lead to Pancoast syndrome.

 

DIF:    Recall             REF:   p. 628            OBJ:   5

 

  1. Which of the following organs is not commonly compromised in metastatic lung cancer?
a. brain
b. liver
c. bone
d. stomach

 

 

ANS:  D

The brain, bones, liver, and adrenal glands are most commonly involved.

 

DIF:    Recall             REF:   p. 628            OBJ:   5

 

  1. The presence of headaches, vision changes, and neurologic symptoms is highly suggestive of metastasis.
a. True
b. False

 

 

ANS:  A

Neurologic symptoms such as headaches, vision changes, and seizures may suggest brain metastases.

 

DIF:    Recall             REF:   p. 628            OBJ:   5

 

  1. What minimum size does a lesion in the lung need to be in order to be called a nodule?
a. 1 cm
b. 2 cm
c. 3 cm
d. 4 cm

 

 

ANS:  C

These will show a small spot (less than 3 cm in diameter) termed a nodule.

 

DIF:    Recall             REF:   p. 628            OBJ:   5

 

  1. What is the most commonly used additional imaging technique to confirm lung cancer?
a. gammagraphy
b. videoscintigraphy
c. positron emission tomography
d. enhanced computed tomography

 

 

ANS:  C

The most commonly used additional imaging technique is positron emission tomography (PET) utilizing [18F]fluorodeoxyglucose.

 

DIF:    Recall             REF:   p. 631            OBJ:   6

 

  1. Which of the following is NOT a common purpose for staging a case of lung cancer?
a. selection of therapy
b. assessment of extent of the disease
c. prognosis
d. etiology

 

 

ANS:  C

One of the major factors that determines the prognosis of lung cancer and guides the proper selection of treatment is the extent to which the cancer has spread in the lungs and throughout the body.

 

DIF:    Recall             REF:   p. 632            OBJ:   7

 

  1. What does the acronym TNM mean?
a. tumor, number, mass
b. tumor, non-small cell, metastases
c. tracheal, number, metastases
d. tumor, lymph node, metastases

 

 

ANS:  D

Non-small-cell lung cancer is staged using the TNM system (“T” for extent of primary tumor, “N” for regional lymph node involvement, and “M” for metastases).

 

DIF:    Recall             REF:   p. 631            OBJ:   7

 

  1. Which of the following pulmonary function tests are frequently used to determine tolerance to resectional surgery?

1 FEV1

  1. FEF25-75
  2. FVC
  3. DLCO
a. 1
b. 1 and 4
c. 2 and 4
d. 1, 2, 3, and 4

 

 

ANS:  B

To determine if an individual will tolerate lung resection surgery, reports of activity tolerance and pulmonary function testing are used. Although no one pulmonary function study or absolute cutoff has proven ideal, the FEV1 and diffusing capacity for carbon monoxide (DLCO) are the most frequently used measures.

 

DIF:    Recall             REF:   p. 634            OBJ:   7

 

  1. Screening of patients at high risk for bronchogenic carcinoma with a chest radiograph has been found to increase survival.
a. True
b. False

 

 

ANS:  B

Despite considerable ongoing debate about the design and analysis of these randomized studies, they have been interpreted as not showing that screening with plain chest radiography and/or sputum examination has a beneficial effect on mortality from lung cancer.

 

DIF:    Recall             REF:   p. 634            OBJ:   7

 

  1. Which of the following is NOT a therapeutic option for patients with lung cancer?
a. surgical resection
b. radiotherapy
c. laser
d. chemotherapy

 

 

ANS:  C

Three classes of treatment are used to treat non-small-cell lung cancer-surgical resection, radiotherapy, and chemotherapy.

 

DIF:    Recall             REF:   p. 634            OBJ:   8

 

  1. What treatment is the best initial modality for patients with non-small-cell lung cancer because it offers the best prospect of long-term survival?
a. chemotherapy
b. surgical resection
c. radiation therapy
d. endobronchial laser therapy

 

 

ANS:  B

Surgical resection offers the best chance of cure for early-stage non-small-cell lung cancer (stages I and II).

 

DIF:    Application    REF:   p. 635            OBJ:   8

 

  1. What is the treatment of choice for limited-stage small-cell lung cancer?
a. surgical resection
b. chemoradiotherapy
c. radiation therapy only
d. chemotherapy only

 

 

ANS:  B

In limited-stage disease, combination chemotherapy with concurrent hyperfractionated radiotherapy is recommended.

 

DIF:    Recall             REF:   p. 632            OBJ:   8

 

  1. What is the most effective way to prevent lung cancer?
a. vitamin E
b. beta-carotene
c. smoking prevention
d. avoidance of atmospheric pollution

 

 

ANS:  C

The most effective way to prevent lung cancer is to prevent smoking.

 

DIF:    Recall             REF:   p. 637            OBJ:   8

 

Chapter 40: Airway Clearance Therapy

Test Bank

 

MULTIPLE CHOICE

 

  1. A normal cough reflex includes which of the following phases?
  2. irritation
  3. inspiration
  4. compression
  5. expulsion
a. 1, 2, 3
b. 1 and 4
c. 1, 2, 3, and 4
d. 2 and 3

 

 

ANS:  C

As shown in Figure 40-1, there are four distinct phases to a normal cough: irritation, inspiration, compression, and expulsion.

 

DIF:    Recall             REF:   p. 963            OBJ:   1

 

  1. Which of the following is/are necessary for normal airway clearance?
  2. patent airway
  3. functional mucociliary escalator
  4. effective cough
a. 1 and 2
b. 1, 2, 3
c. 2 and 3
d. 2

 

 

ANS:  B

Normal airway clearance requires a patent airway, a functional mucociliary escalator, and an effective cough

 

DIF:    Recall             REF:   p. 963            OBJ:   1

 

  1. Which of the following can provoke a cough?
  2. anesthesia
  3. foreign bodies
  4. infection
  5. irritating gases
a. 2 and 4
b. 1, 2, and 3
c. 3 and 4
d. 2, 3, and 4

 

 

ANS:  D

Infection is a good example of cough stimulation due to an inflammatory process. Foreign bodies can provoke a cough through mechanical stimulation. Chemical stimulation can occur when irritating gases are inhaled (e.g., cigarette smoke). Finally, cold air may cause thermal stimulation of sensory nerves and produce a cough.

 

DIF:    Recall             REF:   p. 964            OBJ:   1

 

  1. Which of the following occur(s) during the compression phase of a cough?
  2. expiratory muscle contraction
  3. opening of the glottis
  4. rapid drop in alveolar pressure
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1

 

 

ANS:  D

During the third or compression phase, reflex nerve impulses cause glottic closure and a forceful contraction of the expiratory muscles.

 

DIF:    Recall             REF:   p. 964            OBJ:   1

 

  1. Retention of secretions can result in full or partial airway obstruction. Mucus plugging can result in which of the following?
  2. hypoxemia
  3. atelectasis
  4. Shunting
a. 1, 2, and 3
b. 1 and 2
c. 1 and 3
d. 2 and 3

 

 

ANS:  A

Full obstruction, or mucus plugging, can result in atelectasis and impaired oxygenation due to shunting.

 

DIF:    Recall             REF:   p. 964            OBJ:   1

 

  1. Partial airway obstruction can result in all of the following except:
a. increased work of breathing
b. air-trapping or overdistention
c. increased expiratory flows
d. ventilation/perfusion ratio () imbalances

 

 

ANS:  C

By restricting airflow, partial obstruction can increase the work of breathing and lead to air trapping, overdistention, and ventilation/perfusion () imbalances.

 

DIF:    Recall             REF:   p. 964            OBJ:   1

 

  1. A patient with abdominal muscle weakness is having difficulty developing an effective cough. Which of the following phases of the cough reflex are primarily affected in this patient?
  2. irritation
  3. inspiration
  4. compression
  5. expulsion
a. 1, 2, and 3
b. 2 and 4
c. 2, 3, and 4
d. 3 and 4

 

 

ANS:  D

See Table 40-1.

 

DIF:    Application    REF:   p. 964            OBJ:   1

 

  1. A patient recovering from anesthesia after abdominal surgery is having difficulty developing an effective cough. Which of the following phases of the cough reflex are primarily affected in this patient?
a. irritation
b. inspiration
c. compression
d. expulsion

 

 

ANS:  A

See Table 40-1.

 

DIF:    Application    REF:   p. 964            OBJ:   1

 

  1. A patient with a tracheostomy tube is having difficulty developing an effective cough. Which of the following phases of the cough reflex are primarily affected in this patient?
a. irritation
b. inspiration
c. compression
d. expulsion

 

 

ANS:  C

See Table 40-1.

 

DIF:    Application    REF:   p. 964            OBJ:   1

 

  1. A patient with a neuromuscular disorder causing generalized muscle weakness is having difficulty developing an effective cough. Which of the following cough phases are primarily affected in this patient?
a. irritation
b. inspiration
c. compression
d. expulsion

 

 

ANS:  B

See Table 40-1.

 

DIF:    Application    REF:   p. 964            OBJ:   1

 

  1. All of the following can impair mucociliary clearance in intubated patients except:
a. use of respiratory stimulants
b. tracheobronchial suctioning
c. inadequate humidification
d. high inspired oxygen concentrations

 

 

ANS:  A

Although suctioning is used to aid secretion clearance, it too can cause damage to the airway mucosa and thus impair mucociliary transport. Inadequate humidification can cause inspissation of secretions, mucus plugging, and airway obstruction. High fractional inspired oxygen concentrations (FIO2) can impair mucociliary clearance, either directly or by causing an acute tracheobronchitis.

 

DIF:    Application    REF:   p. 964            OBJ:   1

 

  1. All of the following drug categories can impair mucociliary clearance in intubated patients except:
a. general anesthetics
b. bronchodilators
c. opiates
d. narcotics

 

 

ANS:  B

Several common drugs, including some general anesthetics and narcotic-analgesics, can depress mucociliary transport.

 

DIF:    Application    REF:   p. 964-965     OBJ:   1

 

  1. Conditions that can affect airway patency and cause abnormal clearance of secretions include which of the following?
  2. foreign bodies
  3. tumors
  4. inflammation
  5. bronchospasm
a. 1, 2, and 3
b. 2 and 4
c. 2, 3, and 4
d. 1, 2, 3, and 4

 

 

ANS:  D

Examples include foreign bodies, tumors, and congenital or acquired thoracic anomalies such as kyphoscoliosis. Internal obstruction also can occur with mucus hypersecretion, inflammatory changes, or bronchospasm, further narrowing the lumen.

 

DIF:    Recall             REF:   p. 965            OBJ:   2

 

  1. Which of the following conditions alter normal mucociliary clearance?
  2. bronchospasm
  3. cystic fibrosis (CF)
  4. ciliary dyskinesia
a. 1, 2, and 3
b. 1 and 2
c. 1 and 3
d. 2 and 3

 

 

ANS:  D

Diseases that alter normal mucociliary clearance can also cause secretion retention. CF is a common disorder in this category. In CF, the solute concentration of the mucus is altered because of abnormal sodium and chloride transport. This increases mucus viscosity and impairs its movement up the respiratory tract. Although less common, there are several conditions in which the respiratory tract cilia do not function properly. These ciliary dyskinetic syndromes also can contribute to ineffective airway clearance.

 

DIF:    Application    REF:   p. 965            OBJ:   2

 

  1. Conditions that can lead to bronchiectasis include all of the following except:
a. chronic airway infection
b. muscular dystrophy
c. foreign body aspiration
d. obliterative bronchiolitis

 

 

ANS:  B

Chronic airway inflammation and infection can lead to bronchiectasis, a common finding in both cystic fibrosis and ciliary dyskinetic syndromes. In bronchiectasis, the airway is permanently damaged, dilated, and prone to constant obstruction by retained secretions. Other conditions that can lead to bronchiectasis include chronic obstructive lung diseases, foreign body aspiration, and obliterative bronchiolitis.

 

DIF:    Recall             REF:   p. 965            OBJ:   2

 

  1. All of the following conditions impair secretion clearance by affecting the cough reflex except:
a. muscular dystrophy
b. amyotrophic lateral sclerosis
c. chronic bronchitis
d. cerebral palsy

 

 

ANS:  C

The most common conditions affecting the cough reflex are musculoskeletal and neurological disorders, including muscular dystrophy, amyotrophic lateral sclerosis, spinal muscular atrophy, myasthenia gravis, poliomyelitis, and cerebral palsy.

 

DIF:    Application    REF:   p. 965            OBJ:   2

 

  1. All of the following are goals of airway clearance therapy except:
a. Reverse the underlying disease process.
b. Help mobilize retained secretion.
c. Improve pulmonary gas exchange.
d. Reduce the work of breathing.

 

 

ANS:  A

The primary goal of airway clearance therapy is to help mobilize and remove retained secretions, with the ultimate aim to improve gas exchange and reduce the work of breathing.

 

DIF:    Recall             REF:   p. 965            OBJ:   2

 

  1. Which of the following acutely ill patients is LEAST likely to benefit from application of chest physical therapy?
a. patient with acute lobar atelectasis
b. patient with copious amounts of secretions
c. patient with an acute exacerbation of chronic obstructive pulmonary disease (COPD)
d. patient with low  due to unilateral infiltrates

 

 

ANS:  C

Among the acute conditions for which airway clearance therapy may be indicated are (1) acutely ill patients with copious secretions, (2) patients in acute respiratory failure with clinical signs of retained secretions (audible abnormal breath sounds, deteriorating arterial blood gases, chest radiographic changes), (3) patients with acute lobar atelectasis, and (4) patients with  abnormalities due to lung infiltrates or consolidation.

 

DIF:    Application    REF:   p. 965            OBJ:   2

 

  1. Which of the following conditions are associated with chronic production of large volumes of sputum?
  2. bronchiectasis
  3. pulmonary fibrosis
  4. cystic fibrosis
  5. chronic bronchitis
a. 1, 3, and 4
b. 2 and 4
c. 1, 2, 3, and 4
d. 3 and 4

 

 

ANS:  A

Airway clearance therapy has proved effective in aiding secretion clearance and improving pulmonary function in chronic conditions associated with copious sputum production, including cystic fibrosis and bronchiectasis, and in certain patients with chronic bronchitis.

 

DIF:    Recall             REF:   p. 965            OBJ:   2

 

  1. In general, chest physical therapy can be expected to improve airway clearance when a patient’s sputum production exceeds what volume?
a. 30 ml/day
b. 20 ml/day
c. 15 ml/day
d. 10 ml/day

 

 

ANS:  A

In general, sputum production must exceed 25 to 30 ml/day for airway clearance therapy to significantly improve secretion removal.

 

DIF:    Recall             REF:   p. 965            OBJ:   2

 

  1. Which of the following measures would you use to ask patients for the presence of copious mucus production?
a. 1 pint
b. 1 ounce
c. 1 gallon
d. 1 tablespoon

 

 

ANS:  B

1 ounce is used.

 

DIF:    Recall             REF:   p. 966            OBJ:   2

 

  1. What are the best documented preventive uses of airway clearance therapy?
  2. Prevent retained secretions in the acutely ill.
  3. Maintain lung function in cystic fibrosis.
  4. Prevent postoperative pulmonary complications.
a. 1, 2, and 3
b. 1 and 2
c. 1 and 3
d. 2 and 3

 

 

ANS:  B

The best-documented preventive uses of airway clearance therapy include (1) body positioning and patient mobilization to prevent retained secretions in the acutely ill and (2) postural drainage, percussion, and vibration (PDPV) combined with exercise to maintain lung function in cystic fibrosis.

 

DIF:    Recall             REF:   p. 966            OBJ:   2

 

  1. When assessing the potential need for postoperative airway clearance for a patient, all of the following factors are relevant except:
a. patient’s age and respiratory history
b. nature and duration of current surgery
c. number of prior surgical procedures
d. type of anesthesia (e.g., local versus general)

 

 

ANS:  C

Box 40-3 lists the key factors you must consider when assessing a patient’s need for airway clearance therapy.

 

DIF:    Recall             REF:   p. 966            OBJ:   2

 

  1. All of the following laboratory data are essential in assessing a patient’s need for airway clearance therapy except:
a. chest radiograph
b. pulmonary function tests (PFTs)
c. hematology results
d. ABGs/oxygen saturation

 

 

ANS:  C

Box 40-3 lists the key factors you must consider when assessing a patient’s need for airway clearance therapy.

 

DIF:    Recall             REF:   p. 966            OBJ:   2

 

  1. Key considerations in initial and ongoing patient assessment for chest physical therapy include which of the following?
  2. posture and muscle tone
  3. breathing pattern and ability to cough
  4. sputum production
  5. cardiovascular stability
a. 1, 2, and 3
b. 2 and 4
c. 1, 2, 3, and 4
d. 3 and 4

 

 

ANS:  C

Box 40-3 lists the key factors you must consider when assessing a patient’s need for airway clearance therapy.

 

DIF:    Recall             REF:   p. 966            OBJ:   2

 

  1. Which of the following clinical signs indicate that a patient is having a problem with retained secretions?
  2. lack of sputum production
  3. labored breathing
  4. development of a fever
  5. increased inspiratory and expiratory crackles
a. 2 and 4
b. 1, 2, and 3
c. 3 and 4
d. 1, 2, 3, and 4

 

 

ANS:  D

Bedside findings such as a loose, ineffective cough, labored breathing pattern, decreased/bronchial breath sounds, coarse inspiratory and expiratory crackles, tachypnea, tachycardia, or fever may indicate a potential problem with retained secretions.

 

DIF:    Recall             REF:   p. 966            OBJ:   2

 

  1. All of the following are considered airway clearance therapies except:
a. postural drainage and percussion
b. incentive spirometry
c. positive airway pressure
d. percussion, vibration, and oscillation

 

 

ANS:  B

There are five general approaches to airway clearance therapy, which can be used alone or in combination. These approaches include (1) postural drainage therapy (including turning, percussion, and vibration), (2) coughing and related expulsion techniques, (3) positive airway pressure (PAP) adjuncts (positive expiratory pressure [PEP], continuous PAP [CPAP], expiratory PAP [EPAP]), (4) high-frequency compression/oscillation methods, and (5) mobilization and exercise.

 

DIF:    Recall             REF:   p. 966-967     OBJ:   3

 

  1. The application of gravity to achieve specific clinical objectives in respiratory care best describes which of the following?
a. breathing exercises
b. postural drainage therapy
c. hyperinflation therapy
d. directed coughing

 

 

ANS:  B

Postural drainage therapy involves the use of gravity.

 

DIF:    Recall             REF:   p. 967            OBJ:   3

 

  1. Postural drainage should be considered in all of the following situations except:
a. in patients with chronic obstructive lung disease
b. in patients who expectorate more than 25 to 30 ml sputum per day
c. in the presence of atelectasis caused by mucus plugging
d. in patients with cystic fibrosis or bronchiectasis

 

 

ANS:  A

The AARC has published Clinical Practice Guideline: Postural Drainage Therapy. See CPG 40-1.

 

DIF:    Recall             REF:   p. 968            OBJ:   3

 

  1. Absolute contraindications for postural drainage include which of the following?
  2. head and neck injury (until stabilized)
  3. active hemorrhage with hemodynamic instability
  4. uncontrolled airway at risk for aspiration
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  A

The AARC has published Clinical Practice Guideline: Postural Drainage Therapy. See CPG 40-1

 

DIF:    Recall             REF:   p. 968            OBJ:   3

 

  1. Which of the following is NOT a hazard or complication of postural drainage therapy?
a. cardiac arrhythmias
b. increased intracranial pressure
c. acute hypotension
d. pulmonary barotraumas

 

 

ANS:  D

The AARC has published Clinical Practice Guideline: Postural Drainage Therapy. See CPG 40-1.

 

DIF:    Recall             REF:   p. 969            OBJ:   3

 

  1. Primary objectives for turning include all of the following except to:
a. prevent postural hypotension
b. promote lung expansion
c. prevent retention of secretions
d. improve oxygenation

 

 

ANS:  A

The primary purposes of turning are to promote lung expansion, improve oxygenation, and prevent retention of secretions.

 

DIF:    Recall             REF:   p. 984            OBJ:   3

 

  1. Which if the following is the only absolute contraindication to turning?
a. when the patient cannot or will not change body position
b. when poor oxygenation is associated with unilateral lung disease
c. when the patient has or is at high risk for atelectasis
d. when the patient has unstable spinal cord injuries

 

 

ANS:  D

There are only two absolute contraindications to turning: unstable spinal cord injuries and traction of arm abductors.

 

DIF:    Recall             REF:   p. 968            OBJ:   3

 

  1. Which of the following is/are TRUE of postural drainage?
  2. It is most effective in disorders causing excessive sputum.
  3. It is most effective in head-down positions greater than 25 degrees.
  4. It requires adequate systemic hydration to be effective.
  5. It improves mucociliary clearance in normal subjects.
  6. It improves pulmonary function in stable chronic obstructive pulmonary disease patients.
a. 2 and 4
b. 1, 2, and 3
c. 3 and 5
d. 1, 2, and 4

 

 

ANS:  B

Postural drainage is most effective in conditions characterized by excessive sputum production (greater than 25 to 30 ml/ day). For maximum effect, head-down positions should exceed 25 degrees below horizontal. Postural drainage is not likely to succeed unless and until adequate systemic and airway hydration is ensured.

 

DIF:    Application    REF:   p. 967            OBJ:   3

 

  1. In which of the following patients would you consider modifying any head-down positions used for postural drainage?
  2. a patient with unstable blood pressure
  3. a patient with a cerebrovascular disorder
  4. a patient with systemic hypertension
  5. a patient with orthopnea
a. 1, 2, 3, and 4
b. 2 and 4
c. 2, 3, and 4
d. 2 and 4

 

 

ANS:  A

You may need to modify head-down positions in patients with unstable cardiovascular status, hypertension, cerebrovascular disorders, or dyspnea related to changes in position.

 

DIF:    Analysis         REF:   p. 967            OBJ:   4

 

  1. In setting up a postural drainage treatment schedule for a postoperative patient, which of the following information would you try to obtain from the patient’s nurse?
  2. patient’s medication schedule
  3. patient’s meal schedule
  4. location of surgical incision
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  D

To avoid gastroesophageal reflux and the possibility of aspiration, you should schedule treatment times before or at least 1.5 to 2 hours after meals or tube feedings. If the patient assessment indicates that pain may hinder treatment implementation, you also should consider coordinating the treatment regimen with prescribed pain medication.

 

DIF:    Application    REF:   p. 967            OBJ:   3

 

  1. A patient about to receive postural drainage and percussion is attached to an electrocardiographic (ECG) monitor and is receiving both intravenous (IV) solutions and O2 (through a nasal cannula). Which of the following actions would be appropriate for this patient?
a. Cancel the therapy because the patient cannot be repositioned.
b. Inspect and adjust the equipment to ensure function during therapy.
c. Turn off the ECG monitor, but keep the IV line and O2 going.
d. Turn off the IV line, but keep the monitor on and the O2 going.

 

 

ANS:  B

Inspect any monitoring leads, IV tubing, and O2 therapy equipment connected to the patient; if necessary, make adjustments to ensure continued function during the procedure.

 

DIF:    Analysis         REF:   p. 967            OBJ:   3

 

  1. Which of the following are mandatory components of the preassessment for postural drainage?

 

  1. vital signs
  2. bedside pulmonary function tests
  3. auscultation
a. 1 and 2
b. 2 and 4
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  C

Before starting the procedure, measure the patient’s vital signs and auscultate the chest.

 

DIF:    Application    REF:   p. 967            OBJ:   3

 

  1. If a patient’s chest radiograph shows infiltrates in the posterior basal segments of the lower lobes, what postural drainage position would you recommend?
a. head down, patient supine with a pillow under knees
b. patient prone with a pillow under head, bed flat
c. patient supine with a pillow under knees, bed flat
d. head down, patient prone with a pillow under abdomen

 

 

ANS:  D

See Figure 40-2.

 

DIF:    Analysis         REF:   p. 970            OBJ:   3

 

  1. A physician orders postural drainage for a patient with an abscess in the right middle lobe. Which of the following positions would you recommend for this patient?
a. head down, patient prone with a pillow under abdomen
b. head down, patient supine with a pillow under knees
c. patient supine with a pillow under knees, bed flat
d. head down, patient half-rotated to left, right lung up

 

 

ANS:  D

See Figure 40-2.

 

DIF:    Analysis         REF:   p. 970            OBJ:   3

 

  1. A physician orders postural drainage for a patient with aspiration pneumonia in the superior segments of the left lower lobe. Which of the following positions would you recommend for this patient?
a. patient prone with a pillow under abdomen, bed flat
b. head down, patient prone with a pillow under abdomen
c. head down, patient supine with a pillow under knees
d. patient supine with a pillow under knees, bed flat

 

 

ANS:  A

See Figure 40-2.

 

DIF:    Analysis         REF:   p. 970            OBJ:   3

 

  1. A physician orders postural drainage for a patient with aspiration pneumonia in the anterior segments of the upper lobes. Which of the following positions would you recommend for this patient?
a. head down, patient prone with a pillow under abdomen
b. patient supine with a pillow under knees, bed flat
c. head down, patient supine with a pillow under knees
d. patient prone with a pillow under abdomen, bed flat

 

 

ANS:  B

See Figure 40-2.

 

DIF:    Analysis         REF:   p. 970            OBJ:   3

 

  1. If tolerated, a specified postural drainage position should be maintained for at least how long?
a. 1 to 2 minutes
b. 3 to 5 minutes
c. 20 to 30 minutes
d. 3 to 15 minutes

 

 

ANS:  D

Maintain the indicated position for a minimum of 3 to 15 minutes if tolerated, and longer if good sputum production results.

See Table 40-2.

 

DIF:    Recall             REF:   p. 967            OBJ:   3

 

  1. While reviewing the chart of a patient receiving postural drainage therapy, you notice that the patient tends to undergo mild desaturation during therapy (a drop in SpO2 from 93% to 89% to 90%). Which of the following would you recommend to manage this problem?
a. Increase the patient’s FIO2 during therapy.
b. Discontinue the postural drainage therapy entirely.
c. Discontinue the percussion and vibration only.
d. Decrease the frequency of treatments.

 

 

ANS:  A

See Table 40-2.

 

DIF:    Application    REF:   p. 971            OBJ:   4

 

  1. Why is strenuous patient coughing during postural drainage in a head-down position contraindicated?
a. It can impair the mucociliary clearance mechanism.
b. It can increase expiratory airway resistance (Raw).
c. It can cause air trapping and pulmonary distension.
d. It can markedly increase intracranial pressure (ICP).

 

 

ANS:  D

When using the head-down position, the patient should avoid strenuous coughing, because this will markedly raise ICP.

 

DIF:    Application    REF:   p. 967            OBJ:   3

 

  1. Soon after you initiate postural drainage in a Trendelenburg position, the patient develops a vigorous and productive cough. Which of the following actions would be appropriate at this time?
a. Maintain the drainage position while carefully watching the patient.
b. Move the patient to the sitting position until the cough subsides.
c. Stop the treatment at once and report the incident to the nurse.
d. Drop the head of the bed farther and encourage more coughing.

 

 

ANS:  B

If the procedure causes vigorous coughing, have the patient sit up until the cough subsides.

 

DIF:    Analysis         REF:   p. 971            OBJ:   4

 

  1. All of the following would indicate a successful outcome for postural drainage therapy except:
a. decreased sputum production
b. normalization in ABGs
c. improved breath sounds
d. improvement in chest radiograph

 

 

ANS:  A

Specific outcome criteria indicating a positive response to postural drainage are listed in the AARC Clinical Practice Guideline 40-1: Postural Drainage Therapy. Excerpts appear on pp. 968-969.

 

DIF:    Recall             REF:   p. 974            OBJ:   3

 

  1. All of the following responses indicate that postural drainage should be terminated except:
a. severe tachycardia
b. complaint of discomfort
c. irregular blood pressure
d. severe bradycardia

 

 

ANS:  B

Specific outcome criteria indicating a positive response to postural drainage are listed in the AARC Clinical Practice Guideline 40-1: Postural Drainage Therapy. See CPG 40-1.

 

DIF:    Recall             REF:   p. 974            OBJ:   3

 

  1. Which of the following should be charted after completing a postural drainage treatment?
  2. amount and consistency of sputum produced
  3. patient tolerance of procedure
  4. position(s) used (including time)
  5. any untoward effects observed
a. 1, 2, and 3
b. 2 and 4
c. 1, 2, 3, and 4
d. 3 and 4

 

 

ANS:  C

In your chart entry include the position(s) used, time in position, patient tolerance, subjective and objective indicators of treatment effectiveness (including the amount, color, and consistency of sputum produced) and any untoward effects observed.

 

DIF:    Application    REF:   p. 974            OBJ:   3

 

  1. Percussion should NOT be performed over which of the following areas?
  2. surgery sites
  3. bony prominences
  4. fractured ribs
a. 3
b. 1 and 2
c. 2 and 3
d. 1, 2, and 3

 

 

ANS:  D

Take care to avoid tender areas or sites of trauma or surgery, and never percuss directly over bony prominences, such as the clavicles or vertebrae.

 

DIF:    Recall             REF:   p. 972            OBJ:   3

 

  1. Properly performed chest vibration is applied at what point?
a. throughout inspiration
b. at the end of expiration
c. at the start of inspiration
d. throughout expiration

 

 

ANS:  D

Vibration sometimes is used together with percussion but is limited to application during exhalation.

 

DIF:    Recall             REF:   p. 972            OBJ:   3

 

  1. Directed coughing is useful in helping to maintain airway clearance in all of the following cases except:
a. bronchiectasis
b. acute asthma
c. cystic fibrosis
d. spinal cord injury

 

 

ANS:  B

The AARC has published Clinical Practice Guideline: Directed Cough. See CPG 40-2.

 

DIF:    Recall             REF:   p. 973            OBJ:   3

 

  1. Indications for directed coughing include all of the following except to:
a. enhance other airway clearance therapies
b. help patients with tuberculosis clear secretions
c. help prevent postoperative pulmonary complications
d. obtain sputum specimens for diagnostic analysis

 

 

ANS:  B

The AARC has published Clinical Practice Guideline: Directed Cough. See CPG 40-2.

 

DIF:    Application    REF:   p. 973            OBJ:   3

 

  1. All of the following are contraindications for directed coughing except the presence of:
a. infection spread by droplet nuclei
b. elevated intracranial pressure or intracranial aneurysm
c. reduced coronary artery perfusion
d. necrotizing pulmonary infection

 

 

ANS:  D

The AARC has published Clinical Practice Guideline: Directed Cough. See CPG 40-2.

 

DIF:    Application    REF:   p. 973            OBJ:   3

 

  1. For which of the following patients directed coughing might be contraindicated?
  2. patient with poor coronary artery perfusion
  3. postoperative upper-abdominal surgery patient
  4. long-term care patient with retained secretions
  5. patient with an acute unstable spinal injury
a. 2 and 3
b. 1, 2, and 3
c. 1 and 4
d. 2, 3, and 4

 

 

ANS:  C

The AARC has published Clinical Practice Guideline: Directed Cough. See CPG 40-2.

 

DIF:    Application    REF:   p. 973            OBJ:   3

 

  1. What factors can hinder effective coughing?
  2. artificial airways
  3. neuromuscular disease
  4. systemic dehydration
  5. pain or fear of pain
  6. use of expectorants
a. 1, 2, and 4
b. 2, 4, and 5
c. 1, 2, 3, and 4
d. 1, 2, 3, 4, and 5

 

 

ANS:  C

Some patients with advanced chronic obstructive pulmonary disease or severe restrictive disorders (including neurologic, muscular, or skeletal abnormalities) may not be able to generate an effective spontaneous cough. Likewise, pain or fear of pain caused by coughing may limit the success of directed cough. Systemic dehydration, thick, tenacious secretions, artificial airways, or the use of central nervous system depressants can thwart efforts to implement an effective directed cough regimen.

 

DIF:    Application    REF:   p. 973            OBJ:   3

 

  1. Key consideration in teaching a patient to develop an effective cough regimen includes which of the following?
  2. strengthening of the expiratory muscles
  3. instruction in breathing control
  4. instruction in proper positioning
a. 2 and 3
b. 1 and 2
c. 1, 2, and 3
d. 1 and 3

 

 

ANS:  C

The three most important aspects involved in patient teaching are (1) instruction in proper positioning, (2) instruction in breathing control, and (3) exercises to strengthen the expiratory muscles.

 

DIF:    Application    REF:   p. 973            OBJ:   3

 

  1. What is the ideal patient position for directed coughing?
a. sitting with one shoulder rotated inward, the head and spine slightly flexed
b. supine, with knees slightly flexed and feet braced
c. prone, with the head and spine slightly flexed
d. supine, with forearms relaxed and feet supported

 

 

ANS:  A

The patient should assume a sitting position with one shoulder rotated inward and the head and spine slightly flexed.

 

DIF:    Recall             REF:   p. 974            OBJ:   3

 

  1. A patient recovering from abdominal surgery is having difficulty developing an effective cough. Which of the following actions would you recommend to aid this patient in generating a more effective cough?
  2. coordinating coughing with pain medication
  3. using the forced expiration technique (FET)
  4. supplying manual epigastric compression
  5. “splinting” the operative site
a. 1, 2, and 4
b. 1, 2, and 3
c. 3 and 4
d. 2, 3, and 4

 

 

ANS:  A

The postoperative regimen can be enhanced by coordinating the coughing sessions with prescribed pain medication and assisting the patient in splinting the operative site. This may initially be accomplished by the clinician, using his/her hands to support the area of incision. Eventually, the patient can learn to use a pillow to splint the incision site. The FET may also be of value in these patients.

 

DIF:    Analysis         REF:   p. 975            OBJ:   3

 

  1. Strenuous expiratory efforts in some chronic obstructive pulmonary disease (COPD) patients limit the effectiveness of coughing. Why is this so?
a. The accessory muscles of inspiration oppose the exhalation.
b. All COPD patients have severe abdominal muscle weakness.
c. High expiratory pleural pressures compress the small airways.
d. Strenuous expiration causes the upper airway to collapse.

 

 

ANS:  C

In some patients with COPD, the high pleural pressures during a forced cough may compress the smaller airways and limit the cough’s effectiveness.

 

DIF:    Application    REF:   p. 975            OBJ:   3

 

  1. A chronic obstructive pulmonary disease patient cannot develop an effective cough. Which of the following would you recommend to help this patient generate a more effective cough?
  2. enhancing expiratory flow by bending forward at the waist
  3. using short, expiratory bursts or the “huffing” method
  4. using only moderate (as opposed to full) inspiration
  5. having the patient “tense” the neck muscles while coughing
a. 2 and 4
b. 1, 2, and 3
c. 3 and 4
d. 1, 2, and 4

 

 

ANS:  B

Instruct the patient to slowly take in a moderately deep breath through his or her nose. To help enhance expulsion, have the patient exhale with moderate force through pursed lips, while bending forward. This forward flexion of the thorax enhances expiratory flow by upward displacement of the abdominal contents. After three or four repetitions of this maneuver, encourage the patient to bend forward and initiate short staccato-like bursts of air. This technique relieves the strain of a prolonged hard cough, and the staccato rhythm at a relatively low velocity minimizes airway collapse. This technique has a modification called “huffing” whereby the patient is instructed to make the sound of “huff, huff, huff” rapidly with his or her mouth open.

 

DIF:    Analysis         REF:   p. 975            OBJ:   3

 

  1. A nurse explains to you that a certain neuromuscular patient cannot develop a good cough. Which of the following would you consider to manage this patient’s clearance problem?
  2. combining manual chest compression with suctioning
  3. coordinating the coughing regimen with pain medication
  4. using the autogenic drainage method
  5. using mechanical insufflation-exsufflation
a. 1 and 4
b. 1, 2, and 3
c. 2 and 3
d. 1, 2, and 4

 

 

ANS:  A

If this problem results in retained secretions, there are only three options: (1) placement of an artificial airway and removal of secretions by tracheobronchial suctioning (see Chapter 33), (2) manually assisted cough, and (3) mechanical insufflation-exsufflation.

 

DIF:    Analysis         REF:   p. 975            OBJ:   3

 

  1. Which of the following is false about the FET?
a. It causes less bronchiolar collapse than traditional coughing.
b. It occurs from mid to low lung volume without glottis closure.
c. It has a period of diaphragmatic breathing and relaxation.
d. It occurs from mid to high lung volume without glottis closure.

 

 

ANS:  D

The FET, or huff cough, consists of one or two forced expirations of middle to low lung volume without closure of the glottis, followed by a period of diaphragmatic breathing and relaxation. The goal of this method is to help clear secretions with less change in pleural pressure and less likelihood of bronchiolar collapse.

 

DIF:    Application    REF:   p. 975            OBJ:   3

 

  1. Maintaining an open glottis during coughing (as with the FET) can help to minimize increases in pleural pressure and lessen the likelihood of bronchiolar collapse. Which of the following techniques can aid the practitioner in teaching the patient this maneuver?
a. having the patient inhale slowly through the nose
b. having the patient phonate or “huff” during expiration
c. having the patient “tense” the neck muscles while coughing
d. telling the patient to exert effort, as in straining at stool

 

 

ANS:  B

To help keep the glottis open during an FET, the patient is taught to phonate or “huff” during expiration.

 

DIF:    Application    REF:   p. 975            OBJ:   3

 

  1. Whether using traditional methods or the FET, a period of diaphragmatic breathing and relaxation should always follow attempts at coughing. What is the purpose of this approach?
a. to restore the patient’s SO2
b. to restore lung volume and minimize fatigue
c. to allow the patient time to ask questions
d. to decrease the likelihood of acute air-trapping

 

 

ANS:  B

The period of diaphragmatic breathing and relaxation following the forced expiration is essential in restoring lung volume and minimizing fatigue.

 

DIF:    Application    REF:   p. 975            OBJ:   3

 

  1. What is the correct sequence of actions during the active cycle of breathing (ACB) method?
  2. relaxation and breathing control
  3. three or four thoracic expansion exercises
  4. one or two FETs (huffs)
a. 1, 2, 1, and 3
b. 1, 3, 1, and 2
c. 3, 1, 2, and 1
d. 1, 3, 2, and 1

 

 

ANS:  A

See Box 40-4.

 

DIF:    Recall             REF:   p. 976            OBJ:   3

 

  1. During autogenic drainage, when should patients be encouraged to cough?
a. throughout the procedure
b. after phase 1 only
c. after phase 2 only
d. after phase 3 only

 

 

ANS:  D

Coughing should be suppressed until all three breathing phases are completed.

 

DIF:    Recall             REF:   p. 976            OBJ:   3

 

  1. What does phase 1 of autogenic drainage involve?
a. breathing at low to mid-lung volumes
b. an inspiratory capacity maneuver, followed by breathing at low lung volumes
c. vigorous coughing using the FET
d. progressive breaths at higher and higher lung volumes

 

 

ANS:  B

See Figure 40-6.

 

DIF:    Recall             REF:   p. 976            OBJ:   3

 

  1. What happens during the exsufflation phase of mechanical insufflation-exsufflation?
  2. Airway pressure is abruptly decreased to –30 to –50 cm H2O.
  3. Negative airway pressure is maintained for 2 to 3 seconds.
  4. Peak expiratory “cough” flows reach near normal values.
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  D

The airway pressure is then abruptly reversed to -30 to -50 cm H2O and maintained for 2 to 3 seconds. Peak expiratory “cough” flows obtained with this device are in the normal range (mean of 7.5 L/sec), far better than can be achieved with manually assisted coughing.

 

DIF:    Recall             REF:   p. 977            OBJ:   3

 

  1. A typical mechanical insufflation-exsufflation treatment session should continue until what point?
  2. Secretions are cleared.
  3. The vital capacity (VC) returns to baseline.
  4. The SpO2 returns to baseline.
a. 2 and 3
b. 1 and 2
c. 1, 2, and 3
d. 1 and 3

 

 

ANS:  C

This process is repeated five or more times until secretions are cleared and the VC and SpO2 return to baseline.

 

DIF:    Application    REF:   p. 977            OBJ:   3

 

  1. Under which of the following conditions would mechanical insufflation-exsufflation with an oronasal mask probably NOT be effective?
  2. if the glottis collapses during exsufflation
  3. presence of fixed airway obstruction
  4. presence of a chronic neuromuscular disorder
a. 2 and 3
b. 1 and 2
c. 1, 2, and 3
d. 1 and 3

 

 

ANS:  B

Mechanical insufflation-exsufflation via an oronasal interface is effective, provided that there is no fixed airway obstruction or glottic collapse during exsufflation.

 

DIF:    Application    REF:   p. 977            OBJ:   3

 

  1. Which of the following are potential indications for positive airway pressure therapies?
  2. reduce air-trapping in asthma or chronic obstructive pulmonary disease
  3. help mobilize retained secretions
  4. prevent or reverse atelectasis
  5. optimize bronchodilator delivery
a. 2 and 4
b. 1, 2, and 3
c. 3 and 4
d. 1, 2, 3, and 4

 

 

ANS:  D

The AARC has published Clinical Practice Guideline: Use of PAP Adjuncts to Airway Clearance Therapy. See CPG 40-3.

 

DIF:    Application    REF:   p. 978            OBJ:   3

 

  1. Contraindications for positive airway pressure therapies include all of the following except:
a. intracranial pressure exceeding 20 mm Hg
b. recent facial, oral, or skull surgery or trauma
c. preexisting pulmonary barotrauma (e.g., pneumothorax)
d. air-trapping/pulmonary overdistention in chronic obstructive pulmonary disease

 

 

ANS:  D

The AARC has published Clinical Practice Guideline: Use of PAP Adjuncts to Airway Clearance Therapy. See CPG 40-3..

 

DIF:    Recall             REF:   p. 978            OBJ:   3

 

  1. All of the following are hazards of positive airway pressure therapies (EPAP, PEP, CPAP) except:
a. decreased venous return
b. epistaxis
c. pulmonary barotrauma
d. increased intracranial pressure

 

 

ANS:  B

The AARC has published Clinical Practice Guideline: Use of PAP Adjuncts to Airway Clearance Therapy. See CPG 40-3.

 

DIF:    Recall             REF:   p. 978            OBJ:   3

 

  1. Hazards of positive airway pressure therapies associated with the apparatus used include which of the following?
  2. increased work of breathing
  3. claustrophobia
  4. epistaxis
  5. vomiting and aspiration
  6. skin breakdown and discomfort
a. 1, 3, and 4
b. 2, 3, 4, and 5
c. 1, 2, 3, 4, and 5
d. 3, 4, and 5

 

 

ANS:  C

The AARC has published Clinical Practice Guideline: Use of PAP Adjuncts to Airway Clearance Therapy. See CPG 40-3.

 

DIF:    Recall             REF:   p. 978            OBJ:   3

 

  1. A physician orders positive expiratory pressure therapy for a 14-year-old child with cystic fibrosis. All of the following responses should be monitored on this patient except:
a. peak flow or forced expiratory volume in 1 second (FEV1) per forced vital capacity percentage
b. patient’s minute volume
c. quantity and character of sputum
d. breath sounds

 

 

ANS:  B

The AARC has published Clinical Practice Guideline: Use of PAP Adjuncts to Airway Clearance Therapy. See CPG 40-3.

 

DIF:    Analysis         REF:   p. 978            OBJ:   3

 

  1. Which of the following best describes positive expiratory pressure (PEP) therapy?
a. expiration against a variable flow resistance
b. expiration against a fixed threshold resistance
c. inspiration against a variable flow resistance
d. inspiration against a fixed threshold resistance

 

 

ANS:  A

PEP therapy involves active expiration against a variable flow resistance.

 

DIF:    Recall             REF:   p. 977            OBJ:   3

 

  1. In theory, how does positive expiratory pressure (PEP) help to move secretions into the larger airways?
  2. filling underaerated segments through collateral ventilation
  3. preventing airway collapse during expiration
  4. causing bronchodilation during inspiration
a. 2 and 3
b. 1 and 2
c. 1, 2, and 3
d. 1 and 3

 

 

ANS:  B

In theory, PEP helps move secretions into the larger airways by (1) filling underaerated or nonaerated segments via collateral ventilation and (2) preventing airway collapse during expiration.

 

DIF:    Recall             REF:   p. 977            OBJ:   3

 

  1. Proper instructions for positive expiratory pressure include all of the following except:
a. Take in a breath that is larger than normal, but do not fill lungs completely.
b. Exhale forcefully and maintain an expiratory pressure of 10 to 20 cm H2O.
c. After 10 to 20 breaths, take two or three “huff”’ coughs, and rest as needed.
d. Repeat the cycle 4 to 8 times, not to exceed 20 minutes.

 

 

ANS:  B

See Box 40-5.

 

DIF:    Recall             REF:   p. 979            OBJ:   3

 

  1. A physician orders bronchodilator drug therapy in combination with positive expiratory pressure (PEP). Which of the following methods could you use to provide this combined therapy?
  2. Attach a dry powder inhaler in-line with the PEP apparatus.
  3. Attach a metered-dose inhaler to the system’s one-way valve inlet.
  4. Place a small-volume nebulizer in-line with the PEP apparatus.
a. 2 and 3
b. 1 and 2
c. 1, 2, and 3
d. 1 and 3

 

 

ANS:  A

See Box 40-5.

 

DIF:    Analysis         REF:   p. 979            OBJ:   3

 

  1. What is the movement of small volumes of air back and forth in the respiratory tract at high frequencies (12 to 25 Hz) called?
a. tidal breathing
b. active cycle breathing
c. oscillation
d. huffing

 

 

ANS:  C

As applied to airway clearance, oscillation refers to the rapid vibratory movement of small volumes of air back and forth in the respiratory tract.

 

DIF:    Recall             REF:   p. 980            OBJ:   3

 

  1. Which of the following parts are required to conduct high-frequency external chest wall compression?
  2. variable air-pulse generator
  3. expiratory flow resistor with one-way valve
  4. nonstretch inflatable thoracic vest
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  C

High-frequency chest wall oscillation is accomplished by using a two-part system: (1) a variable air-pulse generator and (2) a nonstretch inflatable vest that covers the patient’s entire torso (The Vest airway clearance system).

 

DIF:    Recall             REF:   p. 980            OBJ:   3

 

  1. All of the following are typical of high-frequency external chest wall compression therapy except:
a. 30-minute therapy sessions
b. oscillations at 5 to 25 Hz
c. one to six sessions per day
d. long inspiratory oscillations

 

 

ANS:  D

Typically, respiratory therapists perform 30-minute therapy sessions at oscillatory frequencies between 5 and 25 hertz (Hz). Depending on need and response, between one and six therapy sessions may occur per day.

 

DIF:    Application    REF:   p. 980            OBJ:   3

 

  1. Which of the following determines effectiveness of high-frequency external chest wall compression therapy?
  2. compression frequency
  3. largest volumes
  4. flow bias
a. 1
b. 2
c. 1 and 3
d. 2 and 3

 

 

ANS:  C

Compression frequency and flow bias (inspiratory versus expiratory) determine the effectiveness of therapy.

 

DIF:    Recall             REF:   p. 980            OBJ:   3

 

  1. The airway clearance technique that uses a pneumatic device to deliver compressed gas minibursts to the airway at rates above 100/min best describes which of the following?
a. intrapulmonary percussive ventilation
b. active cycle of breathing
c. high-frequency external chest wall compression
d. intermittent positive-pressure breathing

 

 

ANS:  D

Intrapulmonary percussive ventilation is an airway clearance technique that uses a pneumatic device to deliver a series of pressurized gas minibursts at rates of 100 to 225 cycles per minute (1.6 to 3.75 Hz) to the respiratory tract, usually via a mouthpiece (Figure 40-11).

 

DIF:    Recall             REF:   p. 980            OBJ:   3

 

  1. Which of the following is true about exercise and airway clearance?
  2. Exercise can enhance mucus clearance.
  3. Exercise can improve pulmonary function.
  4. Exercise can improve matching.
  5. Exercise can cause desaturation in some patients.
a. 1, 3, and 4
b. 1, 2, and 3
c. 1, 2, 3, and 4
d. 2, 3, and 4

 

 

ANS:  C

Adding exercise to mobilization and coughing can further enhance mucus clearance. Exercise also improves overall aeration and ventilation-perfusion matching. Besides increasing sputum production, it can also improve pulmonary function. In addition, exercise can improve a patient’s general fitness, self-esteem, and quality of life. On the other hand, exercise can be fatiguing and result in oxygen desaturation among patients with significant pulmonary impairment.

 

DIF:    Recall             REF:   p. 981            OBJ:   3

 

  1. Patients can control a flutter valve’s pressure by changing what?
a. their inspiratory flow
b. the angle of the device
c. their expiratory flow
d. the expired volume

 

 

ANS:  C

Patients can control the pressure by changing their expiratory flows.

 

DIF:    Recall             REF:   p. 981            OBJ:   3

 

  1. Advantages of the flutter valve over other airway clearance methods include all of the following except:
a. good patient acceptance
b. greater effectiveness
c. full portability
d. independent use

 

 

ANS:  B

The flutter valve is readily accepted by patients, inexpensive, and fully portable and does not require caregiver assistance.

 

DIF:    Recall             REF:   p. 981            OBJ:   3

 

  1. Which of the following is not an advantage of the Acapella over the flutter?
a. It can customize frequency.
b. It can be used in any posture.
c. It is more portable.
d. It can customize flow resistance.

 

 

ANS:  C

The Acapella can customize, based on clinical needs, both the frequency and flow resistance by adjusting the dial. Also, it can be used in any posture, including sitting, standing, and reclining.

 

DIF:    Recall             REF:   p. 981            OBJ:   3

 

  1. Which of the following should be considered when selecting a airway clearance strategy?
  2. patient’s goals, motivation, and preferences
  3. effectiveness and limitations of technique or method
  4. patient’s age, ability to learn, and tendency to fatigue
  5. need for assistants, equipment, and cost
a. 1, 2, and 3
b. 1, 3, and 4
c. 2 and 3
d. 1, 2, 3, and 4

 

 

ANS:  D

See Box 40-6.

 

DIF:    Recall             REF:   p. 982            OBJ:   3

 

  1. Which of the following airway clearance techniques would you recommend for a 15-month-old infant with cystic fibrosis?
a. postural drainage, percussion, and vibration
b. positive expiratory pressure therapy
c. mechanical insufflation-exsufflation
d. intrapulmonary percussive ventilation

 

 

ANS:  A

See Table 40-3.

 

DIF:    Analysis         REF:   p. 982            OBJ:   3

 

  1. Which of the following airway clearance techniques would you recommend for a patient with a neurologic abnormality (bulbar palsy) and intact upper airway?
  2. postural drainage, percussion, and vibration
  3. positive expiratory pressure therapy
  4. mechanical insufflation-exsufflation
a. 2 and 3
b. 1 and 2
c. 1, 2, and 3
d. 1 and 3

 

 

ANS:  D

See Table 40-3.

 

DIF:    Analysis         REF:   p. 982            OBJ:   3

 

  1. In assessing an adult outpatient for airway clearance therapy, you notice the following: (1) no history of cystic fibrosis or bronchiectasis, (2) sputum production of 30 to 50 ml/day, (3) an effective cough, and (4) good hydration. Which of the following would you recommend?
a. postural drainage, percussion, and vibration
b. positive expiratory pressure therapy
c. mechanical insufflation-exsufflation
d. intrapulmonary percussive ventilation

 

 

ANS:  B

See Figure 40-12.

 

DIF:    Analysis         REF:   p. 983            OBJ:   3

 

  1. Which of the following is the most appropriate airway clearance method for an infant with cystic fibrosis?
a. PDPV
b. MIE
c. PEP
d. exercise

 

 

ANS:  A

See Table 40-3. The most suitable airway clearance method for infants is postural drainage, percussion and vibration (PDPV) therapy.

 

DIF:    Application    REF:   p. 982            OBJ:   1

 

  1. What duration of time and pressure is recommended when using MIE devices to clear airways secretions in adults?
a. 30 to 50 cm H2O at 1 to 3 seconds
b. 10 to 30 cm H2O at 1 to 3 seconds
c. 30 to 50 cm H2O at 5 to 10 seconds
d. 10 to 30 cm H2O at 5 to 10 seconds

 

 

ANS:  A

The recommended starting pressure and time for applying MIE to adults is 30-50 cm H2O at 1 to 3 seconds. From there, pressures can be adjusted accordingly.

 

DIF:    Recall             REF:   p. 977            OBJ:   4

 

Chapter 50: Cardiopulmonary Rehabilitation

Test Bank

 

MULTIPLE CHOICE

 

  1. Patients with chronic cardiopulmonary disorders all share an inability to do what?
a. understand the disease process
b. regain functional use of atrophied muscles
c. improve tolerance for physical activity
d. cope effectively with their disease process

 

 

ANS:  D

Although differences in diagnoses can have an impact on treatment outcomes and survival, patients with chronic pulmonary disorders have much in common. All have difficulty coping with the physiologic limitations of their diseases.

 

DIF:    Recall             REF:   p. 1284          OBJ:   1

 

  1. What is the term used to describe the restoration of individuals to the fullest possible medical, mental, emotional, social, and vocational potential?
a. disease prevention
b. rehabilitation
c. intensive care
d. home care

 

 

ANS:  B

The Council on Rehabilitation defines rehabilitation as “the restoration of the individual to the fullest medical, mental, emotional, social, and vocational potential of which he or she is capable.”

 

DIF:    Recall             REF:   p. 1284          OBJ:   1

 

  1. What are the overall goals of rehabilitation?
  2. to reverse the course or progression of the disease process
  3. to minimize the disability’s impact on the individual or family
  4. to maximize the functional ability of the individual
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  B

The overall goal is to maximize the functional ability and to minimize the impact the disability has on the individual, the family, and the community.

 

DIF:    Recall             REF:   p. 1284          OBJ:   1

 

  1. The principal objectives of pulmonary rehabilitation include which of the following?
  2. to control and alleviate the symptoms
  3. to restore functional capabilities as much as possible
  4. to improve quality of life
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  D

The general goals of pulmonary rehabilitation are to control and alleviate the symptoms, restore functional capabilities as much as possible, and improve the quality of life.

 

DIF:    Recall             REF:   p. 1284          OBJ:   1

 

  1. Which of the following would you not expect to observe after a chronic obstructive pulmonary disease (COPD) patient completes a sound pulmonary rehabilitation program?
a. reduced pulse rate during exercise
b. decreased breathing rates during exercise
c. reduction in CO2 production during exercise
d. permanent increase in forced expiratory volume in 1 second (FEV1) and forced expiratory flow (FEF25%-75%)
e. lower minute volumes during exercise

 

 

ANS:  D

Pulmonary rehabilitation does not reverse or stop the disease progression, but it can improve a patient’s overall quality of life.

 

DIF:    Analysis         REF:   p. 1284          OBJ:   1

 

  1. Knowledge from the clinical sciences is used in pulmonary rehabilitation programming for mainly what purpose?
  2. to quantify the extent of physiological impairment
  3. to establish ways to improve the quality of life
  4. to set expectations for reasonable outcomes
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  C

Knowledge from the clinical sciences can help quantify the degree of physiologic impairment and establish outcome expectations for reconditioning.

 

DIF:    Application    REF:   p. 1284          OBJ:   1

 

  1. In which of the following ways does the body respond to increased levels of physical activity?
  2. decreased cardiac output
  3. increased minute ventilation
  4. neuroendocrine stimulation
a. 3
b. 1 and 2
c. 1 and 3
d. 2 and 3
e. 1, 2, and 3

 

 

ANS:  C

Application of the social sciences is helpful in determining the psychological, social, and vocational impact of the disability on the patient and family and in establishing ways to improve the patient’s quality of life.

 

DIF:    Recall             REF:   p. 1284          OBJ:   1

 

  1. Knowledge from the social sciences is used in pulmonary rehabilitation programming for mainly what purpose?
  2. determine the impact of the disability on the patient or family
  3. to quantify the extent of physiological impairment due to disease
  4. to establish ways to improve the patient’s quality of life
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  C

Figure 50-1 shows how the body responds to exercise.

 

DIF:    Application    REF:   p. 1285          OBJ:   1

 

  1. During exercise, the point at which increased levels of lactic acid production result in an increased VCO2 and VE is referred to as what?
a. respiratory quotient (RQ)
b. ventilatory threshold
c. crossover point
d. exercise limit

 

 

ANS:  B

As excess lactic acid is buffered, CO2 levels rise and the stimulus to breathe increases. The result is an abrupt upswing in both CO2 and E (referred to as the ventilatory threshold, or VT).

 

DIF:    Recall             REF:   p. 1285          OBJ:   1

 

  1. Which of the following occur when the ventilatory threshold is exceeded during exercise?
  2. Metabolism becomes anaerobic.
  3. Energy production increases.
  4. Fatigue increases.
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  C

Metabolism becomes anaerobic, the efficiency of energy production decreases, lactic acid accumulates, and fatigue sets in.

 

DIF:    Recall             REF:   p. 1285          OBJ:   1

 

  1. To physically recondition a patient and increase exercise tolerance, which of the following must be accomplished?
  2. The body’s overall O2 utilization must be improved.
  3. The patient’s essential muscle groups must be strengthened.
  4. The cardiovascular response to exercise must be enhanced.
a. 2 and 3
b. 1 and 2
c. 1, 2, and 3
d. 1 and 3

 

 

ANS:  C

Reconditioning involves strengthening essential muscle groups, improving overall oxygen utilization, and enhancing the body’s cardiovascular response to physical activity.

 

DIF:    Recall             REF:   p. 1285          OBJ:   1

 

  1. Attrition in pulmonary rehabilitation programs is most associated with which of the following?
a. success of the physical reconditioning component
b. degree to which patients’ psychosocial needs are met
c. scope and depth of the group educational activities
d. availability of adequate and reliable exercise equipment

 

 

ANS:  B

Studies show that the relative success of reconditioning plays less of a role in determining whether patients complete a program than does meeting their psychosocial support needs.

 

DIF:    Recall             REF:   p. 1287          OBJ:   2

 

  1. Which of the following elements should be considered in most pulmonary rehabilitation programs?
  2. individual needs
  3. patient’s education
  4. patient’s personality
  5. patient’s aptitudes
a. 1, 2, and 3
b. 2 and 4
c. 1, 2, 3, and 4
d. 3 and 4

 

 

ANS:  C

Such a program should be based on the individual needs and expectations of each patient. Not only must each patient’s physical ability be considered, but his or her education, past experience, aptitude, and personality must be considered as well.

 

DIF:    Recall             REF:   p. 1287          OBJ:   1| 2

 

  1. Common goals shared by most pulmonary rehabilitation programs include which of the following?
  2. improvement in physical activity levels
  3. control of respiratory infections
  4. reduction in medical costs and hospitalizations
  5. family education, counseling, and support
a. 1, 2, and 3
b. 2 and 4
c. 1, 2, 3, and 4
d. 3 and 4

 

 

ANS:  C

Pulmonary rehabilitation programs vary in their design and implementation but generally share common goals. Examples of these common goals appear in Box 50-1.

 

DIF:    Recall             REF:   p. 1287          OBJ:   1| 3

 

  1. Which of the following is NOT a reasonable expectation for a pulmonary rehabilitation program?
a. reduction in hospitalizations
b. improvement in ambulation
c. reversal of the disease process
d. control of respiratory infections

 

 

ANS:  C

Pulmonary rehabilitation programs vary in their design and implementation but generally share common goals. Examples of these common goals appear in Box 50-1.

 

DIF:    Recall             REF:   p. 1287          OBJ:   1| 7

 

  1. Specific patient objectives for a pulmonary rehabilitation program could include all of the following except:
a. proper use of medications, O2, and breathing equipment
b. reconditioning of both skeletal and respiratory muscles
c. adherence to proper hygiene and good nutrition
d. improvement in the results of pulmonary function tests

 

 

ANS:  D

Depending on the specific needs of the participants, program objectives can include the following: development of diaphragmatic breathing skills; development of stress management and relaxation techniques; involvement in a daily physical exercise regimen to condition both skeletal and respiratory-related muscles; adherence to proper hygiene, diet, and nutrition; smoking cessation (if applicable); proper use of medications, oxygen, and breathing equipment (if applicable); application of airway clearance techniques (when indicated); focus on group support; and provisions for individual and family counseling.

 

DIF:    Recall             REF:   p. 1287-1288                                  OBJ:   1

 

  1. What is the first step in evaluating patients for participation in a pulmonary rehabilitation program?
a. complete blood gas analysis
b. complete patient history
c. cardiopulmonary stress test
d. pulmonary function testing

 

 

ANS:  B

Patient evaluation begins with a complete patient history: medical, psychological, vocational, and social.

 

DIF:    Recall             REF:   p. 1288          OBJ:   3

 

  1. A patient is being considered for participation in a pulmonary rehabilitation program. Which of the following test regimens would you recommend in order to ascertain the patient’s cardiopulmonary status?
  2. cardiopulmonary exercise evaluation
  3. pulmonary function testing
  4. cardiac catheterization
a. 2 and 3
b. 1 and 2
c. 1, 2, and 3
d. 1 and 3

 

 

ANS:  B

To determine the patient’s cardiopulmonary status and exercise capacity, both pulmonary function testing and a cardiopulmonary exercise evaluation may be performed.

 

DIF:    Application    REF:   p. 1288          OBJ:   3

 

  1. A patient is being considered for participation in a pulmonary rehabilitation program. Which of the following pulmonary function tests would you recommend be performed as a component of the preliminary evaluation?
  2. lung volumes, including functional residual capacity (FRC)
  3. diffusing capacity (DLCO)
  4. pre- and post-bronchodilator flows
  5. lung and thoracic compliance
a. 2 and 4
b. 1, 2, and 3
c. 1, 2, 3, and 4
d. 1, 2, and 4

 

 

ANS:  B

The pulmonary function testing can include assessment of pulmonary ventilation, lung volume determinations, diffusing capacity (DLCO), and prebronchodilator and postbronchodilator spirometry.

 

DIF:    Application    REF:   p. 1288          OBJ:   3

 

  1. A cardiopulmonary exercise evaluation is conducted on a patient before participation in pulmonary rehabilitation for what purposes?
  2. to quantify the patient’s baseline exercise capacity
  3. to develop an exercise prescription (including target heart rate)
  4. to determine how much desaturation occurs with exercise
a. 2 and 3
b. 1, 2, and 3
c. 1 and 2
d. 1 and 3

 

 

ANS:  B

The cardiopulmonary exercise evaluation serves two key purposes in pulmonary rehabilitation. First, it quantifies the patient’s initial exercise capacity. This provides the basis for the exercise prescription (including setting a target heart rate) and also yields the baseline data for assessing a patient’s progress over time. In addition, the evaluation helps determine the degree of hypoxemia or desaturation that can occur with exercise.

 

DIF:    Recall             REF:   p. 1288          OBJ:   3

 

  1. Absolute contraindications for conducting a cardiopulmonary exercise evaluation include all of the following except:
a. diastolic blood pressure greater than 110 mm Hg
b. serious cardiac arrhythmias
c. unstable angina
d. recent myocardial infarction

 

 

ANS:  A

To guide practitioners in implementing exercise evaluation, the AARC has published Clinical Practice Guidelines: Exercise Testing for Evaluation of Hypoxemia and/or Desaturation and Pulmonary Rehabilitation.

 

DIF:    Recall             REF:   p. 1291          OBJ:   3

 

  1. Under which of the following conditions would you recommend ending a cardiopulmonary exercise evaluation?
  2. electrocardiogram indicating supraventricular tachycardia
  3. 10% fall from baseline oxyhemoglobin (HbO2) saturation
  4. fall in systolic blood pressure of more than 20 mm Hg
  5. request from the patient to terminate the test
a. 2, 3, and 4
b. 1, 2, and 3
c. 1, 2, 3, and 4
d. 1, 2, and 4

 

 

ANS:  A

To guide practitioners in implementing exercise evaluation, the AARC has published Clinical Practice Guidelines: Exercise Testing for Evaluation of Hypoxemia and/or Desaturation and Pulmonary Rehabilitation.

 

DIF:    Application    REF:   p. 1291          OBJ:   3| 7

 

  1. While you are assisting in a treadmill cardiopulmonary stress test procedure, the patient complains to you of severe shortness of breath and some chest pain. Which of the following actions would you recommend at this time?
a. Increase the O2 flow rate.
b. Decrease the treadmill speed.
c. Decrease the treadmill incline.
d. Terminate the procedure at once.

 

 

ANS:  D

To guide practitioners in implementing exercise evaluation, the AARC has published Clinical Practice Guidelines: Exercise Testing for Evaluation of Hypoxemia and/or Desaturation and Pulmonary Rehabilitation.

 

DIF:    Analysis         REF:   p. 1291          OBJ:   7| 8

 

  1. All of the following should be monitored during a cardiopulmonary exercise evaluation except:
a. respiratory rate
b. HbO2 saturation
c. ECG and blood pressure
d. FEV1 and FVC

 

 

ANS:  D

The actual exercise evaluation procedure involves serial or continuous measurements of several physiologic parameters during various graded levels of exercise on either an ergometer or a treadmill.

 

DIF:    Recall             REF:   p. 1290          OBJ:   4

 

  1. What are some relative contraindications for cardiopulmonary exercise testing?
  2. severe pulmonary hypertension or cor pulmonale
  3. known electrolyte disturbances (e.g., hypokalemia)
  4. SaO2 or SpO2 less than 85% breathing room air
  5. untreated or unstable asthma
a. 2 and 4
b. 1, 2, and 3
c. 1, 2, 3, and 4
d. 1, 2, and 4

 

 

ANS:  C

Relative contraindications to exercise testing include (1) patients who cannot or will not perform the test, (2) severe pulmonary hypertension/cor pulmonale, (3) known electrolyte disturbances (hypokalemia, hypomagnesemia), (4) resting diastolic blood pressure greater than 110 mm Hg or resting systolic blood pressure greater than 200 mm Hg, (5) neuromuscular, musculoskeletal, or rheumatoid disorders exacerbated by exercise, (6) uncontrolled metabolic disease (e.g., diabetes), (7) SaO2 or SpO2 less than 85% with the subject breathing room air, (8) untreated or unstable asthma, or (9) angina with exercise.

 

DIF:    Recall             REF:   p. 1290          OBJ:   3

 

  1. Which of the following measures during cardiopulmonary exercise evaluation are most useful in differentiating between exercise intolerance of cardiac versus ventilatory origin?
  2. maximum heart rate
  3. O2max
  4. PaCO2
  5. PaO2
a. 2 and 4
b. 1, 2, and 3
c. 3 and 4
d. 2, 3, and 4

 

 

ANS:  C

Table 50-2 summarizes these key similarities and differences.

 

DIF:    Analysis         REF:   p. 1292          OBJ:   3| 8

 

  1. To maximize patient safety during cardiopulmonary stress testing, which of the following precautions would you recommend?
  2. immediate availability of a crash cart
  3. staff training in emergency life support
  4. presence of a physician throughout testing
  5. patient physical exam or ECG before testing
a. 1, 2, and 3
b. 1, 2, 3, and 4
c. 1 and 3
d. 3 and 4

 

 

ANS:  B

To minimize patient risk during exercise evaluation, certain safety measures are implemented. First, the patient should undergo a physical examination just before the test, including a resting ECG. Second, a qualified physician should be present throughout the entire test. Third, emergency resuscitation equipment (cardiac crash cart with monitor, defibrillator, oxygen, cardiac drugs, suction, and airway equipment) must be readily available. Fourth, staff conducting and assisting with the procedure should be certified in basic and advanced life support techniques. Last, the test should be terminated promptly whenever indicated.

 

DIF:    Application    REF:   p. 1292          OBJ:   3| 8

 

  1. In preparing an outpatient for a cardiopulmonary stress test to be conducted the next day, which of the following instructions would you provide?
  2. The patient should fast for at least 8 hours before testing.
  3. The patient should wear loose-fitting clothing and sneakers.
  4. The patient should stop all medications at once.
  5. The patient should review the drugs with the physician.
a. 1, 2, and 3
b. 2 and 4
c. 1, 2, 3, and 4
d. 1, 2, and 4

 

 

ANS:  D

With regard to test preparation, patients should fast 8 hours before the procedure. If the purpose of the test is to formulate an exercise prescription, the patient can take his or her regular medications. The patient should wear comfortable, loose-fitting clothing and footwear with adequate traction for treadmill or ergometer activity. The mouthpiece or face mask used during the test should be sized properly and fit comfortably with no leaks.

 

DIF:    Application    REF:   p. 1292          OBJ:   3

 

  1. Which of the following patients are NOT good candidates for pulmonary rehabilitation?
  2. unstable cardiovascular patients who require monitoring
  3. patients with exercise limitations due to severe dyspnea
  4. patients with malignant neoplasms involving the lungs
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  C

Indications for pulmonary rehabilitation are listed in Box 50-4.

 

DIF:    Application    REF:   p. 1292          OBJ:   3

 

  1. Which of the following patients would benefit least from pulmonary rehabilitation?
a. patient with chronic bronchitis
b. patient with pulmonary emphysema
c. patient with pulmonary fibrosis
d. patient with malignant lung cancer

 

 

ANS:  D

Indications for pulmonary rehabilitation are listed in Box 50-4.

 

DIF:    Recall             REF:   p. 1292          OBJ:   3

 

  1. Which of the following patients are good candidates for pulmonary rehabilitation?
  2. those with malignant neoplasms involving the lungs
  3. those with severe arthritis or neuromuscular abnormalities
  4. those with exercise limitations due to severe dyspnea
  5. those with moderate to severe obstructive lung disease
a. 1, 2, and 3
b. 2 and 4
c. 3 and 4
d. 2, 3, and 4

 

 

ANS:  C

Indications for pulmonary rehabilitation are listed in Box 50-4.

 

DIF:    Application    REF:   p. 1292          OBJ:   3

 

  1. The O2max at termination of exercise (as a percentage of the predicted) for five patients appears below. Which of these patients is the best candidate for pulmonary rehabilitation?

O2max (predicted)

a. 65%
b. 80%
c. 90%
d. 95%

 

 

ANS:  A

Patients in whom there is a respiratory limitation to exercise resulting in termination at a level less than 75% of the predicted maximum oxygen consumption (O2max).

 

DIF:    Analysis         REF:   p. 1292          OBJ:   1

 

  1. Below what level of the predicted FEV1/FVC are patients with irreversible airway obstruction considered good candidates for pulmonary rehabilitation?
a. 75%
b. 80%
c. 60%
d. 70%

 

 

ANS:  C

Patients in whom there is significant irreversible airway obstruction with a forced expiratory volume in 1 second (FEV1) of less than 2 L or an FEV1% (FEV1/FVC) of less than 60%.

 

DIF:    Recall             REF:   p. 1292          OBJ:   3

 

  1. Which of the following patients with irreversible airway obstruction are the best candidates for pulmonary rehabilitation?
  Patient FEV1 FEV1/FVC
1. A 3.2 L 65%
2. B 1.6 L 67%
3. C 2.3 L 53%
4. D 3.1 L 72%

 

a. 2 and 4
b. 1, 2, and 3
c. 2 and 3
d. 1, 2, 3, and 4

 

 

ANS:  C

Patients in whom there is significant irreversible airway obstruction with an FEV1 of less than 2 L or an FEV1% (FEV1/FVC) of less than 60%.

 

DIF:    Analysis         REF:   p. 1292          OBJ:   3

 

  1. Which of the following pulmonary function tests are most useful in determining whether a patient with restrictive lung disease should be considered for pulmonary rehabilitation?
  2. DLCO
  3. total lung capacity (TLC)
  4. FEV1/FVC
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  A

DLC and TLC are the most useful pulmonary function tests to evaluate the need of pulmonary rehabilitation of patients with restrictive lung disease. Patients in whom there is a significant restrictive lung disease with a TLC of less than 80% of predicted and single-breath carbon monoxide-diffusing capacity (DLCO) of less than 80% of predicted.

 

DIF:    Application    REF:   p. 1292          OBJ:   3

 

  1. For which of the following patients would you recommend an open-ended format for a pulmonary rehabilitation program?
  2. those with scheduling difficulties
  3. those who require individual attention
  4. those who are self-directed
a. 2 and 3
b. 1 and 2
c. 1, 2, and 3
d. 1 and 3

 

 

ANS:  C

This format is good for self-directed patients, or those with scheduling difficulties. It also may be the best format for patients requiring individual attention.

 

DIF:    Application    REF:   p. 1293          OBJ:   4

 

  1. To increase the likelihood that positive patient results are lasting, what must pulmonary rehabilitation programs provide?
a. vocational and social counseling
b. staff training in rehabilitation methods
c. financial support for rehospitalization
d. periodic follow-up and reinforcement

 

 

ANS:  D

Follow-up or reinforcement could be open-ended (available during regular rehabilitation sessions and offering open attendance) or could be scheduled weekly, monthly, bimonthly, or quarterly. The important thing is to have some type of follow-up available.

 

DIF:    Application    REF:   p. 1293          OBJ:   4

 

  1. The physical reconditioning component of a pulmonary rehabilitation program usually includes which of the following?
  2. aerobic exercises for the extremities
  3. timed walking exercise
  4. ventilatory muscle training
a. 1, 2, and 3
b. 2 and 3
c. 1 and 3
d. 3

 

 

ANS:  A

Typically, the exercise prescription includes the following four related components: (1) lower extremity (leg) aerobic exercises, (2) timed walking (6-minute or 12-minute walk), (3) upper extremity (arm) aerobic exercises, and (4) ventilatory muscle training.

 

DIF:    Recall             REF:   p. 1294          OBJ:   4

 

  1. Which of the following exercises are useful for reconditioning the lower extremities of patients undergoing pulmonary rehabilitation?
  2. walking on a flat surface for a specified period of time
  3. walking on a treadmill for a specified distance or time
  4. pedaling a stationary bicycle for a specified distance
a. 2 and 3
b. 1 and 2
c. 1, 2, and 3
d. 1 and 3

 

 

ANS:  C

Lower extremity exercises may include either walking or bicycling. Patients can walk on a stationary treadmill (with set goals for distance or time and grade) or on a flat, smooth surface. Patients can bicycle on an exercise cycle. With the treadmill or stationary bicycle, patients are required to cover a certain distance or duration every day that they are in the program.

 

DIF:    Application    REF:   p. 1295          OBJ:   4

 

  1. A patient in your pulmonary rehabilitation program has an orthopedic disability that precludes her from walking or using a stationary bicycle. Which of the following activities would you recommend to help recondition the lower extremities?
a. use of a rowing machine
b. calisthenic exercises
c. aquatic exercises
d. use of a treadmill

 

 

ANS:  C

Patients with significant orthopedic disabilities can participate in aerobic aquatic exercises.

 

DIF:    Application    REF:   p. 1295          OBJ:   4

 

  1. Which of the following exercises are useful for reconditioning the upper extremities of patients undergoing pulmonary rehabilitation?
  2. using a rowing machine
  3. using an arm ergometer
  4. pedaling a stationary bicycle
  5. using free hand weights
a. 1, 2, 3, and 4
b. 1 and 3
c. 1, 2, and 4
d. 2 and 4

 

 

ANS:  C

Arm ergometers or rowing machines are available for this purpose; however, simple calisthenics using either a broomstick or free weights (by prescription and with training) are a satisfactory alternative.

 

DIF:    Application    REF:   p. 1295          OBJ:   4

 

  1. Reconditioning the inspiratory muscles of patients undergoing pulmonary rehabilitation is accomplished through which of the following methods?
a. walking aerobically for a specified time
b. using a rowing machine for a specified time
c. pedaling a stationary bicycle for a specified distance
d. performing inspiratory resistive breathing exercises

 

 

ANS:  D

Ventilatory muscle training is based on the concept of progressive resistance.

 

DIF:    Application    REF:   p. 1295          OBJ:   4

 

  1. Which of the following is/are true about the flow-resistor breathing exerciser?
  2. Exhaled gas flows unimpeded out a one-way valve.
  3. Resistance is created by a variable-size orifice.
  4. Imposed load varies with the rate of flow.
a. 2 and 3
b. 1, 2, and 3
c. 1 and 2
d. 2

 

 

ANS:  C

Varying the size of this orifice varies the inspiratory load, as do changes in the patient’s inspiratory flow. During expiration, gas flows unimpeded out the one-way exhalation valve. Other types of devices are also available. One model replaces the variable size orifice with an adjustable spring-loaded valve. This ensures a relatively constant load regardless of how fast or slowly the patient breathes.

 

DIF:    Application    REF:   p. 1295          OBJ:   4

 

  1. During inspiratory resistive exercises, the desired load should be about what percentage of the maximum inspiratory pressure?
a. 15%
b. 25%
c. 30%
d. 20%

 

 

ANS:  C

If the patient’s inspiratory pressure is less than 30% of the measured PImax, the next smaller orifice is selected, with this procedure repeated until the 30% effort is consistently achieved.

 

DIF:    Recall             REF:   p. 1296          OBJ:   4

 

  1. Which of the following educational topics covered in a typical pulmonary rehabilitation program are most suitable for presentation by a respiratory care practitioner?
  2. methods of relaxation and stress management
  3. recreation and vocational counseling
  4. diaphragmatic and pursed-lip breathing techniques
  5. respiratory structure, function, and disease
a. 2 and 4
b. 1, 2, and 3
c. 3 and 4
d. 1, 2, 3, and 4

 

 

ANS:  D

Table 50-5 provides an example of topics covered during a 12-week rehabilitation program.

 

DIF:    Recall             REF:   p. 1296          OBJ:   5

 

  1. Which of the following health professionals would be best for conducting a pulmonary rehabilitation session on methods of relaxation and stress management?
a. clinical psychologist
b. physical therapist
c. respiratory therapist
d. pulmonary physician

 

 

ANS:  A

Table 50-5 provides an example of topics covered during a 12-week rehabilitation program.

 

DIF:    Recall             REF:   p. 1296          OBJ:   5| 6

 

  1. Which of the following health professionals would be best for conducting a pulmonary rehabilitation session on recreation and vocational counseling?
a. physical therapist
b. respiratory therapist
c. clinical psychologist
d. occupational therapist

 

 

ANS:  D

Table 50-5 provides an example of topics covered during a 12-week rehabilitation program.

 

DIF:    Recall             REF:   p. 1296          OBJ:   5| 6

 

  1. Which of the following topics should be covered in a rehabilitation education session on respiratory home care?
  2. self-administration of therapy
  3. care of home equipment (e.g., cleaning)
  4. safe use of home care equipment
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  D

Table 50-5 provides an example of topics covered during a 12-week rehabilitation program.

 

DIF:    Recall             REF:   p. 1296          OBJ:   5

 

  1. Appropriate topical areas to be covered in a rehabilitation education session on nutrition include which of the following?
  2. elements of a good diet
  3. proper eating habits
  4. foods to avoid
  5. daily menu planning
a. 1, 2, and 3
b. 2 and 4
c. 1, 2, 3, and 4
d. 3 and 4

 

 

ANS:  C

Dietary guidelines focus on weight management and good nutrition as they relate to cardiopulmonary health. Emphasis should be on the importance of a sound high-protein, low-carbohydrate diet. The facilitator also should cover proper eating habits, methods of gaining and losing weight, foods to avoid, ways to increase appetite, and daily menu planning. This session will stimulate patients to eat better.

 

DIF:    Recall             REF:   p. 1297          OBJ:   5

 

  1. A small-group discussion format for pulmonary rehabilitation educational sessions is recommended in order to foster which of the following?
  2. group interaction
  3. peer support
  4. group identity
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  D

To foster group identity, interaction, and support, small-group discussions are encouraged.

 

DIF:    Application    REF:   p. 1298          OBJ:   6

 

  1. What is the ideal class size for pulmonary rehabilitation programs?
a. 5 to 15
b. 10 to 20
c. 20 to 30
d. 3 to 10

 

 

ANS:  D

The ideal class size should range from 3 to 10 participants.

 

DIF:    Recall             REF:   p. 1298          OBJ:   6

 

  1. A small pulmonary rehabilitation program class size has which of the following beneficial effects?
  2. It facilitates group interaction.
  3. It allows for more individualized attention.
  4. It helps to sustain participant motivation.
  5. It reduces the likelihood of attrition.
a. 2 and 4
b. 1, 2, and 3
c. 3 and 4
d. 1, 2, 3, and 4

 

 

ANS:  D

Keeping the class size manageable facilitates vital group interaction processes and allows for more individualized attention. These factors help sustain motivation, thereby reducing the likelihood of participant attrition.

 

DIF:    Recall             REF:   p. 1298          OBJ:   6

 

  1. Minimum equipment requirements for the physical reconditioning component of a pulmonary rehabilitation program include which of the following?
  2. inspiratory resistive breathing devices
  3. rowing machines or upper extremity ergometers
  4. pulse oximeters (for pulse rate/SaO2)
  5. stationary bicycles
a. 1, 2, and 3
b. 2 and 4
c. 1, 2, 3, and 4
d. 3 and 4

 

 

ANS:  C

For physical reconditioning, stationary bicycles, treadmills, rowing machines, upper extremity ergometers, weights, pulse oximeters, and inspiratory resistance breathing devices represent the minimum equipment requirements.

 

DIF:    Application    REF:   p. 1298          OBJ:   6

 

  1. To deal with incidents of hypoxemia, dyspnea, or airway hyperreactivity during physical reconditioning activities, which of the following should be available in the rehabilitation area?
  2. intubation tray
  3. bronchodilator agents
  4. emergency oxygen
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  B

Emergency oxygen and bronchodilator medications should also be maintained in the rehabilitation area.

 

DIF:    Application    REF:   p. 1298          OBJ:   6| 8

 

  1. Which of the following is NOT a factor affecting the cost of a pulmonary rehabilitation program?
a. space and utility expenses
b. equipment and supplies
c. patient health insurance
d. program promotion costs

 

 

ANS:  C

Several factors must be considered when projecting program costs (Box 50-5).

 

DIF:    Application    REF:   p. 1299          OBJ:   6| 7

 

  1. By following the reimbursement guidelines for a comprehensive outpatient rehabilitative facility (CORF), Medicare will reimburse up to what percentage of the allowable charge for a rehabilitation program?
a. 60%
b. 80%
c. 20%
d. 40%

 

 

ANS:  B

By following recognized guidelines, Medicare will be able to establish an allowable charge for the program and reimburse 80% of this rate after the patient meets the annual prescribed deductible.

 

DIF:    Recall             REF:   p. 1300          OBJ:   1

 

  1. Which of the following are legitimate ways to obtain reimbursement from third-party payers for pulmonary rehabilitation programs?
  2. charge sessions as physical therapy exercises for COPD patients
  3. charge sessions as office visits with therapeutic exercises
  4. charge sessions as physician office visits—intermediate
a. 2 and 3
b. 1 and 2
c. 1, 2, and 3
d. 1 and 3

 

 

ANS:  D

Box 50-6 provides a listing of all possible sources of reimbursement.

 

DIF:    Recall             REF:   p. 1300          OBJ:   6

 

  1. What government programs can serve as a source for reimbursement for pulmonary rehabilitation?
  2. prospective payment system (PPS)
  3. comprehensive outpatient rehabilitative facility (CORF)
  4. Veterans Administration benefits
  5. Civilian Health and Medical Programs of the Uniformed Services (CHAMPUS)
a. 1, 2, and 3
b. 2 and 4
c. 1, 2, 3, and 4
d. 2, 3, and 4

 

 

ANS:  D

Box 50-6 provides a listing of all possible sources of reimbursement.

 

DIF:    Recall             REF:   p. 1300          OBJ:   6

 

  1. Which of the following outcome measures is considered a major predictor for improvement in a COPD patient’s health-related quality of life?
a. frequent attendance in a maintenance program
b. repeated admission to a rehabilitation program
c. frequent medical evaluations
d. antibiotic therapy

 

 

ANS:  A

One of the major predictors for improvement in a COPD patient’s health-related quality of life is frequent attendance in a maintenance program.

 

DIF:    Recall             REF:   p. 1301          OBJ:   7

 

  1. For which of the following procedures pulmonary rehabilitation has become recognized as a prerequisite?
a. thoracotomy
b. lung volume reduction surgery
c. lung transplantation
d. heart transplantation

 

 

ANS:  B

Pulmonary rehabilitation has become recognized as a prerequisite for certain emphysema patients who are able to undergo lung volume reduction surgery.

 

DIF:    Recall             REF:   p. 1302          OBJ:   7

 

  1. Common cardiovascular hazards of physical reconditioning for patients with chronic lung disease include which of the following?
  2. cardiac arrhythmias
  3. systemic hypotension
  4. muscle contractures
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  B

Potential hazards include the following (1) cardiovascular abnormalities, such as cardiac arrhythmias (can be reduced with supplemental oxygen during exercise) and systemic hypotension and hypertension tension; (2) blood gas abnormalities (arterial desaturation, hypercapnia, and acidosis); and (3) muscular abnormalities (functional or structural injuries, diaphragmatic fatigue and failure, and exercise-induced muscle contracture).

 

DIF:    Application    REF:   p. 1302          OBJ:   9

 

  1. Where are most cardiac rehabilitation programs conducted?
a. private practice offices
b. clinics
c. hospital facilities
d. homes

 

 

ANS:  C

Most cardiac rehabilitation programs are conducted within a hospital facility, and these programs are generally divided into monitored and maintenance segments, with home options available. Exercise prescriptions are individualized for participating patients in an effort to maximize outcomes and reduce the likelihood of adverse effects.

 

DIF:    Recall             REF:   p. 1302          OBJ:   6

 

  1. Which of the following are differences between cardiac and pulmonary rehabilitation?
  2. Cardiac patients are typically younger.
  3. Most cardiac patients are not able to walk for 1 hour.
  4. Reimbursement is easier to obtain with cardiac rehabilitation.
  5. Breathing exercises are not essential to cardiac patients.
a. 1 and 2
b. 2 and 3
c. 1, 3, and 4
d. 1, 2, and 3

 

 

ANS:  C

Differences include disease focus, patient age (most cardiac patients will range from their late 30s on up to their 60s and 70s, while pulmonary patients, for the most part, will be 50 years or older), and exercises used within the program. Many cardiac patients will walk for up to 1 hour, while this may be virtually impossible for most respiratory patients. On the other hand, breathing exercises to improve ventilation are essential to the respiratory patient but are not that important to patients with cardiovascular diseases. Reimbursement variables between the two types of programs also exist, with cardiac rehabilitation being more recognized by insurance payers.

 

DIF:    Recall             REF:   p. 1302          OBJ:   6

 

  1. What is the level of involvement of the respiratory therapist in cardiac rehabilitation?
a. same as in the pulmonary rehabilitation
b. greater than in pulmonary rehabilitation
c. significantly less than in pulmonary rehabilitation
d. respiratory therapist does not participate in cardiac rehabilitation

 

 

ANS:  C

Respiratory involvement in cardiac rehabilitation is significantly less.

 

DIF:    Recall             REF:   p. 1303          OBJ:   6

 

  1. Which of the following clinicians are commonly involved in the cardiac rehabilitation programs?
  2. nurse specialist
  3. cardiologist
  4. dietitian
a. 1 and 2
b. 2 and 3
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  A

Most often, the cardiologist and cardiac nurse specialist are involved with program facilitation and administration.

 

DIF:    Recall             REF:   p. 1303          OBJ:   6

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